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34 Cards in this Set
- Front
- Back
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what is definition of therapeutic exercise?
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exercise performed at a level of physical exertion to improve health or correct physical deformity
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what is active exercise?
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voluntary contraction and relaxation of specific muscle groups
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what is active assistive exercise?
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voluntary contraction of muscles, but assisted by therapist or by some other means (the practitioner helps along or uses modality)
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according to OTPFW what are OT interventions?
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1. occupation based
2. purposeful activity 3. preparatory methods |
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what is the biomechanical FOR?
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1. ROM
2. Strength- produce tension in a muscle or group of muscles when a dynamic or static force is applied 3. Endurance (activity tolerance) – physical conditioning 4. Kinematic – amount and direction of m/m & speed 5. Torque – amount of force to cause m/m -Closer or further away (activity is placed from their body) changes effort |
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what is resistive exercise
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any form of active exercise in which a static or dynamic muscular contraction is achieved by an outside force.
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name 3 types of resistive exercise
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1. manual resistive exercise (MMT) used in early stages of exercise, typically for someone that has weakness
2. mechanical resistive exercise (MRE) 3. progressive resistive exercise (PRE) |
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what is Manual resistance exercise?
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-provided by practitioner
-not measured quantitatively (b/c of test/retest reliability) -used in early stages of exercise program for weak muscles (mild to moderate resistance) -proprioceptive neuromuscular facilitation (PNF) may be used for manual resistive exercise (grade manual resistance in stages) |
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what is manual resistance exercise used for?
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1. Used to Evaluate ROM and Strength
2. Demonstrate the desired motion to the patient 3. Practitioner applies resistance throughout the range (like demonstrated with andrea’s shoulder) 4. Patient performs with maximum effort |
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Applying Manual Resistance Exercise
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1. determine the direction of resistance
2. modify degree of resistance if: a. the pt. is unable to complete full ROM b. resistance produces pain c. visible muscle tremor d. substitution occurs e. intolerance symptoms -SOB |
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give example of determining the direction of resistance when applying manual resistance exercise...
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EX: to strengthen the anterior deltoid apply resistance over the distal humerus
(because you need to determine the direction of resistance --applied to the distal end of the segment; opposite the direction of motion) |
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review:
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examples of manual resistive exercise pics:
(shoulder flexion) -examples of isometric exercise |
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what are isometric exercise?
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muscle contraction with no change in length or visible joint motion
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what is the purpose of isometric exercise?
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a. used to prevent muslce atrophy in early rehab phase (secondary to immobilization) (sometimes used in burn unit and ICU)
b. static muscle contraction is used to maintain joint mobility c. may increase strength and endurance if reistance held for at least 6 seconds |
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what are clinical conditions are good for isometric exercise?
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1. joint replacements
2. rotator cuff repair 3. post fracture healing 4. burns 5. CVA |
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what is isotonic exercise?
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1. same or constant tension
2. manually vary the resistance throughout the range of motion 3. apply as muscle shortens or lengthens |
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what is isokinetic exercise?
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1. Mechanical device controls or limits the speed of movement
2. Vary the amount of resistance applied through the range 3. Creates maximum tension in muscle at all points during the range 4. Example: Cybex |
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what is mechanical resistance exercise?
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1. Active exercise – resistance applied through equipment
2. Amount of resistance - measured quantitatively 3. Resistance is progressed & graded over time 4.Referred to as Progressive Resistive Exercise (PRE) 5. Used when manual resistance cannot produce the desired outcome 6. Example: UNEX II Exercise System $2295 |
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what are examples of mechanical resistive exercise?
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1. figure 8 board system
2. bilateral sander 3. nesar shoulder glide |
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what are the indications for resistance exercise?
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1. Increase strength
A. Produce tension in a muscle or group of muscles B. Contract against gravity C. Hold against maximum resistance D. Muscle grade of 3-4 |
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what factors influence strength?
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1. size of the muscle --the larger the diameter, the greater the strength
2. recruitment of motor units --the greater the number of motor units firing, the greater the force of output 3. types of contraction 4. speed of contraction 5. intensity 6. motivation of the patient 7. patients who can't perform max strength |
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what is type I of muscle fibers
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tonic fibers--anaerobic
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what do type I muscle fibers do?
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-generate low level of muscle tension
-sustain contraction -slow to fatigue -postureal muscles holds body erect against gravity -if shortened use intervention: stretch/inhibit; co-activation (when use NDT); strengthening |
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what can you do for core strengthening?
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-neurodevelopmental (NDT) - trunk co-activiation
-proprioceptive neuromuscular facilitation - trunk and pelvic patters -universal ball or bolster |
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what is type II muscle fibers?
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(phasic fibers) fast twitch muscles - aerobic metabolic act. (high O2 requirement)
-a lot of muscle tension in a short time -fatigue quickly -burst of tension- propelling forward on crutches, running |
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what are the guidelines for strength exercise
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1. Exercise muscle to point of fatigue
(load exceeds muscle capacity) 2. High load for a low number of repetitions to the point of fatigue (Power) 3. Moving low load for a high number of repetitions to point of fatigue (Power) 4. Duration (10-20 seconds) |
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How do you increase endurance (activity tolerance)?
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1. Low intensity, repetitive exercise over a prolonged period of time
2. Mild resistance for many repetitions 3. Occupation based example: rolling bread dough, washing car, wax on/wax off |
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What is progressive resistive exercise
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1. Resistance applied by some mechanical means
2. Quantified and increased over time 3. Load resisting exercise is performed in an antigravity position if the muscle grade is Fair or better (muscle grade 3) 4. Gravity eliminated if poor to fair 5. EX: If the abductors of the arm poor plus place patient in supine on a skate board |
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how do you determine # of reps?
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1. Repetition Maximum (RM) depends on the greatest amount of load a muscle can move through the range for a specific number of times
2. How much weight can be lifted and lowered 10 times 3. If a patient can lift & lower 5 pounds with elbow flexors for a maximum of 10 repetitions 4. In O of SoAP note! The 10 repetition maximum is 5 pounds; if 5 pounds is lifted more than 10 times increase weight by ½ pound increments for 10 times (then increase repetitions) need to use this formula to demonstrate why use the amount of reps we choose! 5. As strength of muscle increases - increase the resistance |
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repetition maximum/PRE
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1 Free Weights
2 Dumbbells 3 Barbells 4 Cuff weights 5 Sand bags |
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what is the least resistant thera-band
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yellow
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what is the most resistant thera-band
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black
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what are contraindications for therapeutic exercise?
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BP – 200/110 or 80/50
Resting HR > 100 Decrease HR with activity Acute fever Dizziness Blood transfusion (anemia, reduced platelet count < 100) Hemoglobin less than 10 Stenosis (in carotid artery) Angina – chest pain Dyspnea – SOB ECG abnormalities – ST segment changes, arrhythmias, atrial fibrillation Thrombophebitis Borg Perceived Exertion Scale Score > 13 on 6-20 scale |
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Documentation
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ICD 9 - Primary Diagnosis Code – 436 CVA
ICD 9- Secondary Diagnosis Code – why OT is treating – generalized muscle weakness – 728.87 CPT code – 97110- therapeutic exercise 4. Timed code 1 unit: 8 minutes to < 23 minutes 2 units: 23 minutes to < 38 minutes 3 units: 38 minutes to < 53 minutes 4 units: 53 minutes to < 68 minutes 5 units: 68 minutes to < 83 minutes 6 units: 83 minutes to < 98 minutes 5. Short term goal- In order to don shirt over head (against gravity), pt .will increase (B) UE strength from grade 2/5 to 3/5 using PRE with mod A for with set up in 3 weeks |
