Werk 8 Flashcards
Guidelines for Heart Health
Step Counts - 10000
Moderate-intensity activity -150 min
Vigorous-intensity activity - 75 min
Can also be a combination of Moderate and Vigorous
➢Combination of Types of Cardio is Best
Guidelines for children and adolescents
➢Children and adolescents ages 6 through 17 should get at least 60 minutes of moderate-to-vigorous physical activity per day.
➢Vital for normal Development
Levels of Cardiac Intensity
Max Heart Rate= 220 – Age
•Zone 1:
➢ Recovery or very light intensity, usually 50–60% of your HRmax
•Zone 2:
➢Aerobic or light intensity, usually 60–70% of your HRmax
•Zone 3:
➢Aerobic/anaerobic or moderate intensity, usually 70–80% of your HRmax
•Zone 4:
➢Anaerobic or hard intensity, usually 80–90% of your HRmax
•Zone 5:
➢Maximal or very hard intensity, usually 90–100% of your HRmax
Guidelines for Strength Training
Adults should get at least 2-3 days of muscle-strengthening activity per week.
All muscle groups
For emphasis on strength, use 3-6 reps per set and allow 2-5 minutes of rest between sets.
•For emphasis on endurance, do 12-20 reps per set and rest for 30 seconds between sets
Lift your max
Technique/Proper Form is critical to avoid injury.
•Soreness does not mean injury.
For highly individuals who are highly deconditioned, it is possible to experience gastrointestinal issues at the start of a new program.
Additional Factors to Incorporate in a Fitness Program
➢Balance
➢Agility
➢Endurance
➢Mobility
➢Flexibility
➢Coordination
➢Creating a Mind Body Connection
➢Breathing
➢Technique
Basic Types of Exercise
Active
➢Patient assists or performs independently using voluntary muscle contraction.
•Passive
➢Patient is unable or not permitted to move.
Considerations
Effect of gravity
•Amount and type of stability and support necessary
•Purpose of the exercise
•Ability of patient to participate
•Safety measures to avoid injury and prevent an increase in symptoms
Support
Promote motion or movement
•Relieve stress to joint or body area
•Control the weight of extremity or body part
•Compensate for loss of muscle strength
Stabilization
Prohibits, limits, or avoids movement
•Protects the site of healing fracture
•Protects soft tissue subject to extensive trauma or damage
•Protects healing musculotendinous structure
•Prohibits movement of an uninvolved joint or body part
•Grasp above and below the site.
•Outside force may be used
Cardinal or Anatomic Planes of Motion
Sagittal: vertical plane that divides body into left and right components (flexion and extension)
•Frontal: vertical plane that divides the body into front (anterior) and back (posterior) components (abduction and adduction—except for thumb)
•Transverse: horizontal plane that divides the body into upper and lower components (rotation)
Indications for PROM Exercise
Patient unable to perform active exercise
•To avoid active exercise of unhealed fracture
•To counteract negative effects of immobilization
•To evaluate joint ROM and flexibility
•To provide sensory stimulation and awareness
•To reduce cardiopulmonary stress
Benefits of PROM Exercise
Maintains existing ROM
•Minimizes development of muscle shortening or other complications due to immobilization
•Maintains circulation
•Maintains patient’s sensory awareness
•Promotes cartilage nutrition and movement of synovial fluid
•Reduces or inhibits pain
Limitations of PROM Exercise
Cannot prevent muscle atrophy
•Cannot maintain muscle tone, strength, or contractile endurance
•Cannot reduce adipose tissue
Indications for AROM Exercise
Patient able to voluntarily contract, control, and coordinate muscle(s)
•Used when there are no contraindications for use
•Benefits desirable for fulfilling patient’s goals
•Caution used when soft tissue or joint pain or joint swelling is apparent
Benefits of AROM Exercise
Maintaining physiologic elasticity, strength, and contractile endurance of muscle
•Increasing local circulation
•Increasing sensory awareness
•Preventing complications in the cardiovascular system
•Maintaining structural integrity
•Improving muscle strength
Preparation for ROM Exercise
Examine and evaluate patient.
•Obtain information from medical record.
•Determine goals and type of exercise to use.
•Introduce yourself and explain the purpose, risks, and desired outcomes.
•Obtain patient permission.
•Position the patient and yourself.
Principles: PROM Exercise
Provide gentle, firm support and proper stabilization.
•Move through entire unrestricted, normal ROM of a joint (end feel).
•Give special consideration to multijoint muscles.
•Give special considerations to how the patient’s diagnosis affects the exercise program
Position patient properly.
•Perform passive movement in the direction opposite to the movement that the muscle would produce.
Advantages of Diagonal Patterns (PNF) for ROM Movements
Incorporates rotation in all movements
•Incorporates crossing the midline with many of the movements
•Incorporates more functional movements
•Incorporates combination of motions within each pattern
Types of Muscle Contractions
Three types
➢Isotonic: visible joint movement
•Eccentric: fibers lengthen
•Concentric: fibers shorten
➢Isometric: no or little observable joint movement and no significant change in muscle length; with or without external resistance
➢Isokinetic: requires specific equipment to control the speed of patient’s contractions and produces variable resistance throughout the range
Active Assistive Exercise (Isotonic)
Requires patient to actively contract muscle(s)
•Requires external assistance (manual, mechanical and/or gravitational forces)
•Requires modifying amount of assistance in response to patient’s ability to move through the range
•Requires that the caregiver follow previously discussed techniques
Active Exercise (Isotonic)
Patient performs without assistance or resistance other than gravity and the weight of the extremity or segment involved.
•Patient must have the ability to move through the full range without assistance (fair muscle grade).
Position patient depending on how you want gravity to affect the exercise(s).
•Encourage smooth, controlled movement and use appropriate speed.
•Encourage brief pauses at start and end positions.
•A brief rest between each series of reps
Active Resistive Exercise (Isotonic
Requires addition of resistive force other than gravity
•Position the patient appropriately.
•Stabilize the proximal component or origin of muscle being exercised.
•The resistance requires the patient to use a maximal contraction.
•Follow previously discussed principles.
Isometric Exercise
Active: muscle contracts without movement at the joint; “tighten, hold, relax”
•Resistive: apply resistance perpendicular to the segment for 5 to 8 seconds and relax for 5 to 8 seconds; strengthening
Precautions
Consider Precautions (Pertaining to Exercise) for the following diagnoses?
➢RA
➢MS
➢SCI
➢COPD (or other respiratory conditions)
➢MCI
➢Total Joint Replacement
What is the difference between acquired brain injury (ABI) and traumatic brain injury (TBI)?
TBI is generally defined as an insult to the brain from an external source.
▪ ABI includes TBI, cerebrovascular accident (CVA), brain illness/infection, and any other brain injury acquired after birth.
Open head injury (OHI
occurs when the skull is penetrated, such as by a bullet, and typically involves focal damage (confined to a small part of the brain
closed head injury (CHI
does not involve penetration of the skull but results in both focal and broad diffuse damage (occurring throughout the brain).
Coup-contra-coup
When a TBI is the result of a car accident or other external force to one side of the head, a “coup-contra-coup” (front-to-back or side-to-side) effect can occur—that is, bouncing back and forth within the skull injures the area of the brain opposite the initial injury
Diffuse Axonal Injury (DAI)
Not caused by a blow or impact to the head, but by the brain moving with acceleration and deceleration as well as compression and stretching inside the skull, often causing injuries to many parts of the brain.
▪The axon get broken and stretched in many places. This shearing injury, or tissue sliding over tissue results in the death of brain cells, which also causes swelling.
▪ Once those nerve cells are disrupted and the links between them are broken, the signal process cannot occur, and such functions as movement, speech, and even those that support life cannot occur.
Anoxia
▪Anoxic brain injury can also be called cerebral hypoxia or hypoxic–anoxic injury and is a serious and life-threatening insult to the brain.
▪After 4 minutes of significantly low oxygen levels, brain cells begin to die, and after 5 minutes, permanent anoxic brain injury can result. The greater the lack of oxygen, the more widespread and serious the injury will be.
Glasgow Coma Scale
Measures three parameters—eye movements, verbal responses, and motor responses; overall scores can range from 3 to 15. Lower scores indicate a more severe brain.
▪Used in acute stages
Rancho Level of Cognitive Functioning Scale (LCFS)
▪8-10 Levels
▪Do all clients go through all levels in order?
▪OT intervention is often planned and structured based on client’s LCFS level.
Symptoms and Treatment: Rancho Level I
▪Does not respond to external stimulation. Clients at level I do not open their eyes and do not respond to painful stimuli.
▪Acute care or ICU
▪Position to prevent skin breakdown and manage tone
▪Provide PROM to prevent contractures
▪Educate family
Symptoms and Treatment: Rancho Level II
Reacts to stimulation inconsistently in a nonspecific, non-purposeful manner and is considered to be in a vegetative state.
May be in an acute care hospital, LTAC, or inpatient rehabilitation facility.
▪OT Treatment: Positioning; PROM; use of orthotics, sensory stimulation; and family education.
Symptoms and Treatment: Rancho Level III
▪Client responds in a specific manner to stimuli, but responses may be delayed and inconsistent
▪Minimally conscious state and OT is focused on sensory stimulation and family education
▪Acute, Rehab Hospital, or LTAC
▪Treatment:
▪May have increased tone (hypertonicity or spasticity), and OT will include positioning and possibly orthoses for management of increased tone.
▪PROM to prevent contracture
Symptoms and Treatment: Rancho Level IV
Behavior may be bizarre and inappropriate, with poor attention and short-term memory.
▪May demonstrate impulsivity, balance deficits, poor safety awareness, and agitation
▪May be in an inpatient rehabilitation facility unless the medical condition requires a higher level of care. The client is also likely exhibiting poor insight into the deficits
▪May require restraints because of their poor safety awareness.
▪OT plan of care is focused on attention, safety awareness, behavior management, and ADLs/IADLs.
▪Therapeutic use of self is crucial, as the demeanor and tone of voice used by the OT practitioner can affect the client’s
Symptoms and Treatment: Rancho Level V
Confusion and inappropriate responses, but the individual is no longer as agitated. Memory and attention continue to be impaired and the client is not able to retain new information
▪May still be in an inpatient rehabilitation facility or subacute rehabilitation facility or may have transitioned to his or her home with 24-hour supervision and home health or outpatient OT services.
Symptoms and Treatment: Rancho Level V1
Continues to demonstrate difficulties with recent memory but is able to use external cues for direction
▪Responses are typically appropriate in the context of the situation.
Twenty-four-hour supervision is likely still required because of memory deficits, and the client may be in a rehabilitation facility or at home with home health or outpatient services, depending on the client’s medical status and the families’ ability to provide care.
Symptoms and Treatment: Rancho Level VII
Behavior is becoming more appropriate in familiar settings and carryover of new learning is beginning to be evident, although at a slower rate than before the TBI.
At this point, the client is likely receiving OT services in an outpatient or home health setting, and vocational rehabilitation services may be involved to address skills needed to return to work.
Symptoms and Treatment: Rancho Level VIII
Appropriate responses to the environment.
Vocational rehabilitation services assist the client in developing the skills needed to return to a previous job or a different job.
▪OT plan of care focused on higher-level cognitive skills, including medication management, money management, community integration, and home management, and driving
