Pta 220 - Unit 2

Front 1

Definition of joint mobilization

Back 1

Manual therapy techniques that are used to modulate pain and treat joint dysfunctions that limit ROM by specifically addressing the altered mechanics of the joint.

Front 2

What is the difference between the 5 grades of peripheral joint mobilizations?

Back 2

1 - Small amplitude at beginning of available joint motion

2 - Larger amplitude in the middle of available joint motion

3 - Large amplitude from the mid-range to end-range of available joint motion

4 - Small amplitude at the end-range of available joint motion

5 - High velocity thrust

Front 3

Indications for joint mobilization

Back 3

• Pain, muscle guarding, and spasm
  
• Reversible joint hypo mobility
  
• Positional faults/subluxations
• Progressive limitation
• Functional immobility

Front 4

Contraindications for joint mobilization

Back 4

Hypermobility

Joint Effusion

Inflammation

Front 5

What is the concave/convex rule and how does it apply to joint mobilization?

Back 5

If the surface of the moving bone is convex, sliding is in the opposite direction of the segment's movement

If the surface of the moving bone is concave, sliding is in the direction of the segment's movement

Front 6

What are patient/therapist considerations when choosing interventions that affect soft tissue?

Front 7

Posterior glide of the humerus increases what?

Back 7

Flexion

Front 8

Anterior glide of the humerus increases what?

Back 8

Extension

Front 9

Inferior (caudal) glide of the humerus increases what?

Back 9

Abduction

Front 10

Dorsal glide of the wrist increases what?

Back 10

Flexion

Front 11

Volar glide of the wrist increases what?

Back 11

Extension

Front 12

Ulnar glide of the wrist increases what?

Back 12

Radial Deviation

Front 13

Radial glide of the wrist increases what?

Back 13

Ulnar Deviation

Front 14

Posterior glide of the tibia increases what?

Back 14

Knee Flexion

Front 15

Anterior glide of the tibia increases what?

Back 15

Knee Extension

Front 16

Anterior glide of the femur increases what?

Back 16

Extension and ER

Front 17

Posterior glide of the femur increases what?

Back 17

Flexion and IR

Front 18

Long axis distraction of the hip increases what?

Back 18

Pain control, general mobility

Front 19

Reasons for altered mechanics:

Back 19

• Muscle guarding
  
• Pain
  
• Effusion
  
• Contractures
  
• Adhesions
  
• Bony mal-alignment
  

Front 20

Purpose of joint mobilizations?

Back 20

Replicate the desired normal joint mechanics

Minimize the abnormal stresses on the cartilage/joint.

Front 21

Conditions requiring special precautions for joint mobilization:

Back 21

Pregnancy, bone disease, unhealed fractures, total joint replacements, acute post op, systemic connective tissue diseases (RA), elderly

Front 22

What are some signs and symptoms of excessive fatigue?

Back 22

Dyspnea

Dizziness

Increased Pain

Intermittent claudication

Pallor/Diaphoresis

• Stop Treatment!! Find a chair and let pt rest - alert nurse.

Front 23

What is the role of the PTA in a cardiac rehab phase one?

Back 23

PTA sees 2nd treatment (PT is 1st)

Obtain permission from nurse to treat pt - they have the most up to date vital info and knows how the pt faired overnight

Progress from initial eval status as indicated - Alert PT/nurse if anything changes for the worse

Front 24

Cardiac Rehab: Phase One Patient Education

Back 24

• Benefits of increased mobility, detriments of prolonged bed rest
  
• Protection of sternum
  
• Appropriate there ex with warm up/cool down
  
• RPE scale usage
  
• Smoking cessation
  
• ADL restrictions
  
• Encourage Phase Two Rehab
  

Front 25

Cardiac Rehab Transfer precautions

Back 25

• Protect the sternum - do NOT log roll - have pt scoot diagonally and make sure to assist from behind, not pulling on shoulders
  
• Be cautious of all lines/tubes
  
• Check with nurse on chest tube protocols
  
• Can typically disconnect the monitor leads from the machine (NOT the pt), O2, Sat line, POSSIBLY the chest tube suction
  

Front 26

Cardiac Rehab Gait precautions

Back 26

• Encourage pursed lip breathing
  
• Encourage rest breaks as needed
  
• Monitor O2 sats while ambulating and document in chart
  
• Start with RW and profess to cane or SBA as indicated
  
• ALWAYS wear gait belt, but avoid all incision lines
  
• Stair training if allowed and needed for home
  

Front 27

Cardiac Rehab: Phase Two

Back 27

• Outpatient Rehab
  
• Pt is on monitor entire visit
  
• Pt will have passed an ETT, ther ex prescribed based on results
  
• CO and EF most important determinants
  
• FITT equation used
  
• One on one guided exercise by nurse or exercise physiologist
  

Front 28

Example visit protocol: Phase Two Cardiac Rehab

Back 28

• 3 min bike (legs only), heart beats monitored and anything irregular are recorded
  
• Repeat 3-4xs, check recovery time and document
  
• Progress 1 min each visit
  
• Progress to Airdyne (UE and LE)
  
• 15 min sustained, can add TM
  
• 30 min sustained, can DC to Phase Three
  

Front 29

Phase Three Cardiac Rehab

Back 29

• Can now begin strength training regimen
  
• Overall strengthening to enhance return to ADL
  
• Usually not covered by insurance
  
• Can be a personal trainer, or may send to PT for general strengthening to get insurance coverage
  
• Pt is NOT on heart monitor, but BP and HR
  

Front 30

Phase Three: Strengthening exercise guidelines

Back 30

• Not until 8 weeks post op CABG and at least 3 weeks of completed cardiac rehab
  
• Exercise large muscle groups first
  
• Avoid Valsalva
  
• Avoid prolonged gripping
  
• Slow/Controlled movements
  
• Cessation if adverse response
  

Front 31

Components of a typical physical therapy evaluation for a patient who has a cardiac and/or pulmonary impairment:

Back 31

(Phase One Rehab) - usually begins 1 day s/p CABG

PT eval: PMH, social situation, pain, cognition, strength of all extremities, monitor vitals, transfer ability, gait ability, begin pt/family education, set goals ,declare rehab potential, set d/c plan

Front 32

Goals for Acute Care with cardiac diseases:

Back 32

• Pt education of disease process, post-op activity restrictions, and behavior modifications
  
• Increase cardiopulmonary efficiency
  
• Increase peripheral strength to improve performance of ADL's and IADL's
  
• Enhance self-managemtn of symptoms and disease process - recognize symptom irritants and onsets
  

Front 33

Cardiac Conditioning for the Healthy population:

Back 33

• Exercise at a percentage of MHR
• 60-70% MHR is required to achieve a cardiac conditioning response
• AHA recommends 30 minutes aerobic activity daily

*** MHR for cardiac patients is symptom limited

Front 34

Pulmonary Diseases - PT eval:

Back 34

PMH, social situation, pain, cognition, strength of all extremities, monitor vitals, transfer ability, gait ability, begin pt/family education, set goals, declare rehab potential, set d/c plan

Front 35

Goals for Acute Care with Pulmonary Diseases

Back 35

• Pt education of disease process
• Increased cardiopulmonary efficiency
• Improved performance with ADL's and IADL's
• Decreased energy expenditure with breathing
• Enhanced self-managment of symptoms and disease process
• Improve peripheral strength and postural alignment

Front 36

PT Interventions for pulmonary diseases

Back 36

• Obtain permission from nurse to treat patient - they have the most up to date vital info and know how the patient did overnight
  
• Progress from initial eval status as indicated. Alert PT/nurse if anything changes for the worse.
  
• Always check O2 stats pre/post activity
  
• Allow rest breaks as needed, document appropriately
• RPE limits the interventions length and intensity
• General strengthening exercises in sitting as a warm up and in standing AS ABLE for most functional carry over

Front 37

Pulmonary Disease - Patient Education

Back 37

• Benefits of increased mobility, detriments of prolonged bed rest
• RPE scale usage
• Smoking cessation
• ADL modifications and energy conservation techniques
• Pursed lip breathing (PLB)
• Diaphragm exercises
• General strengthening/postural exercises

Front 38

Diaphragmatic technique:

Back 38

Tactile input at diaphragm; verbal cues to decrease use of accessory muscles. Quick stretch then applied prior to inhalation; graded manual resistance PRN

Front 39

Lateral expansion technique

Back 39

Tactile input at lateral inferior borders of chest wall; verbal cues to feel that section expand with inhalation. Quick stretch then applied prior to inhalation; graded manual resistance PRN

Front 40

Postural Drainage Precautions:

Back 40

• Now commonly managed with vibration vests

• Precautions:

1. No trendelenburg (supine, head lower than feet) for: CHF, hypertension, pulmonary edema, obesity, abdominal distension, hiatal hernia or nausea
2. No side lying for: axillofemoral bypass graft, arthritis, bursitis/tendonitis of shoulder/hip
3. No percussion for: coagulation disorders, impaired bone integrity, hemoptysis (coughing up blood)

Front 41

Postural Drainage Contraindications:

Back 41

Broken Ribs, Osteoporosis

Front 42

Duration of postural drainage percussions:

Back 42

3-5 minutes, followed by 1 minute of shaking

Front 43

Positions for postural drainage:

Back 43

Front 44

Indications for aquatic therapy:

Back 44

• Decreased mobility
• Impaired balance
• Spasticity
• Chronic Pain
• Degenerative Joint Disease
• Decreased strength
  

Front 45

Contraindications for aquatic therapy:

Back 45

• Fever
• Infection
• Exposed wounds
• Incontinence of bowel/bladder
• Unstable cardiac conditions
• Unstable respiratory conditions
• Kidney dysfunction
• Severe PVD
• Uncontrolled seizures

Front 46

Aquatic therapy precautions:

Back 46

• Fear of water
• Cardiac history
• Diabetes
• Safety with maneuvering around pool facilities
• Pulmonary history
• Impaired cognition or communication

Front 47

Specific Heat

Back 47

Slow to heat up, slow to cool down

Front 48

Thermal conductivity

Back 48

Transfers heat quickly, therefore able to to heat (or cool) the body quickly

Front 49

Buoyancy

Back 49

Upward thrust on the body, opposite of gravity

Front 50

Archimede's Principle

Back 50

A body will have an upward thrust equal to the amount of water displaced. Offers "active assistance" to ther ex. Affected by the object's density

Front 51

Surface Tension

Back 51

Molecules at the surface have a greater tendency to stick to each other - therefore the surface will have a higher tension than below

Front 52

Adhesion

Back 52

Tendency of water molecules to stick to other surfaces (why you drip dry)

Front 53

Viscosity

Back 53

Resistance to the flow of a liquid due to friction created among the molecules when disturbed. Creates turbulence when water sis disturbed - Streamlined effects vs drag

Front 54

Streamline

Back 54

A teardrop line of count our offering the least possible resistance to a current of air, water, etc

Front 55

Turbulence

Back 55

Movement of water in a circular pattern to create eddy currents - opposite of streamline - disruption of water molecules from resting position

Front 56

Hydrostatic pressure

Back 56

Pressure exerted by a fluid on a body immersed in that fluid - good for edema control

Front 57

Pascal's Law

Back 57

The deeper the body is immersed, the greater the pressure - a submerged segment has equal pressure to all parts

Front 58

Benefits of shallow water

Back 58

Weight reduction (25% at knee deep, 50% at waist deep)

Front 59

Benefits of deep water

Back 59

Weight reduction (75% at chest deep)

Front 60

Water temp for rehab/therapy

Back 60

90-95

Front 61

Water temp for arthritis

Back 61

83-90

Front 62

Water temp for cool water vigorous exercise

Back 62

83-86

Front 63

Water temp for competitive swimming

Back 63

78-82

Front 64

Water temp for the obese

Back 64

80-86

Front 65

Cardiovascular and pulmonary changes that occur with submersion in water

Back 65

Pulmonary - decreased VC, increased energy expenditure to breathe

Cardiovascular - hydrostatic pressure displaces venous blood proximally, which increases cardiac volume, stroke volume, and cardiac output

Front 66

Patient education for aquatic therapy

Back 66

• Specific goals for each exercise (purpose)
• what they should/shouldn't feel
• parameters
• technique

Front 67

What is an example of a buoyancy resisted exercise?

Back 67

Pushing noodle down through the water

Front 68

What is an example of a buoyancy assisted exercise?

Back 68

Allowing the water to help bring a noodle back to the surface

Front 69

Gait Cycle

Back 69

Heel strike of one foot to the next heel strike of the same foot.

Always measured as the same side, same portion of gail phase (may not always be heel strike)

60% stance phase, 40% swing phase, and two periods of double support (heel strike-toe off)

Front 70

Stance Phase

Back 70

60% of Gait Cycle

Front 71

Swing Phase

Back 71

40% of Gait Cycle

Front 72

Double Support Phase

Back 72

Both feet touching ground

Front 73

Step Cadence

Back 73

Number of steps taken in a given period of time

Front 74

Step Length

Back 74

Point of heel strike of one LE to the point of heel strike of the other LE

Front 75

Stride Length

Back 75

Distance covered during the gait cycle

Front 76

Foot Slap

Back 76

Weakness of anterior tibialis; foot slaps ground due to no eccentric control

Front 77

Lack of heel strike

Back 77

Leg length discrepancy, heel cord contracture, heel pain

Front 78

Toe drag

Back 78

Lack of DF; toes never clear the ground due to lack/weakness of anterior tibialis

Front 79

Excessive knee flexion

Back 79

Weakness in quads, flexion contracture, muscle guarding with knee pain, leg length discrepancy

Front 80

Genu recurvatum

Back 80

Knee hyperextension due to lack of joint stability; locked into hyperextension by ligamental and bony support

Front 81

Excessive hip flexion (steppage)

Back 81

Used with foot drop to try to avoid toe drag - like you're trying to step over something

Front 82

Hip Circumduction

Back 82

Weak iliopsoas, weak anterior tibialis; circumducts rather than forward advancement

Front 83

Hip hiking

Back 83

Weak hamstrings, weak anterior tibialis, fused or braced knee

Front 84

Trendelenburg

Back 84

Excessive trunk lateral flexion to compensate for weak glute meds on stance side, and prevent pelvic drop on swing through side; or protect a painful hip

Front 85

Antalgic

Back 85

Protective of painful area, shortened step length; uneven cadence, may coincide with additional abnormal patterns

Front 86

Ataxic

Back 86

Unsteadiness due to lack of control of proprioception

Front 87

Festinating

Back 87

Repetitive tip-toe pattern for patients with Parkinson's Disease. Uncontrollable gait, comes to an abrupt halt at an object

Front 88

Hemiplegic

Back 88

Circumduction of hip for momentum to advance the flaccid extremity

Front 89

Parkinsonian

Back 89

Flexed knees and trunk, shuffling gait (with occasional festination)

Front 90

Scissor

Back 90

Leg crosses midline during swing through

Front 91

Spastic Diplegia

Back 91

Cerebral Palsy "controlled fall" pattern (40-50% of patients with CP)

Typically with hip add, hip IR, hip flexion, knee flexion, PF

Momentum and velocity maintain upright posture with gait

Front 92

What is Rhythmic Auditory Stimulation?

Back 92

Using music to elicit rhythmical step patterns and cues - can be used to relax fear of falling prior to or during treatment - can also be used as a stimulating or inhibiting cue

Front 93

Partial toe amputation

Back 93

Excision of any part of one or more toes

Front 94

Toe disarticulation

Back 94

Disarticulation at the metatarsal phalangeal joint

Front 95

Partial foot/ray resection

Back 95

Resection of the 3rd, 4th, 5th metatarsals and digits

Front 96

Transmetatarsal amputation

Back 96

Amputation through the midsection of all metatarsals

Front 97

Ankle disarticulation (SYMES)

Back 97

Ankle disarticulation with attachment of heel pad to distal end of tibia; may include removal of malleoli and distal tibial/fibular flares

Front 98

Long transtibial amputation

Back 98

BKA - More than 50% of tibial length

Front 99

Short transtibial amputation

Back 99

BKA - Less than 20% of tibial length

Front 100

Knee disarticulation

Back 100

Amputation through the knee joint; femur intact

Front 101

Long transfemoral amputation

Back 101

AKA - More than 60% of femoral length

Front 102

Transfemoral amputation

Back 102

AKA - Between 35% -60% of femoral length

Front 103

Short transfemoral amputation

Back 103

AKA - Less than 35% of femoral length

Front 104

Hip disarticulation

Back 104

Amputation through hip joint; pelvis intact

Front 105

Hemipelvetomy

Back 105

Resection of lower half of the pelvis

Front 106

Hemicorportectomy

Back 106

Amputation of both lower limbs and pelvis below L4-L5 level

Front 107

Posterior flap closure

Back 107

Leaves a scar line anteriorly across the limb

Front 108

Equal flap closure

Back 108

Equal length anterior/posterior closures - leaves a horizontal scar at midline of the limb.

Front 109

What are the 2 leading causes of amputation?

Back 109

PVD - leading cause for LE amputations, especially when coupled with smoking and diabetes

Trauma - most commonly from MVA or gunshot/military trauma

Front 110

Neuroma

Back 110

A bundle of nerve tissue - painful if compressed. Must sufficiently pad the area

Front 111

Phantom pain

Back 111

Cramping, squeezing, shooting/burning pain in an area that no longer exists

Front 112

Phantom sensations

Back 112

Tingling, burning, itching, pressure or numbness in an area that no longer exists

Front 113

How can mirror therapy help decrease the phantom pains of a RL?

Back 113

It allows the mind to "see" the missing limb and can potentially help decrease the noxious sensations by "treating" the reflected limb.

Front 114

Rigid compression dressing

Back 114

Plaster casting molded to keep limb in desired shape - not removable

Advantages: decreased edema, decreased pain, earlier ambulation, earlier transition to permanent prosthesis

Front 115

Removable rigid compression dressing

Back 115

Plaster or plastic that can be removed to checking healing/signs of infection/wounds

Advantages: decreased edema, decreased pain, earlier ambulation, earlier transition to permanent prosthesis

Front 116

Semi-rigid compression dressing

Back 116

Unna style boot. Provides medicinal protection against infection, not as much support as rigid

Front 117

Soft compression dressing

Back 117

Elastic wraps or shrinker sock

Advantages: inexpensive, light weight, clean

Disadvantages: poor edema control, can cut off circulation if wrapped incorrectly or slips with movement, frequent reapplication needed

Front 118

What is a Syme's prosthesis?

Back 118

Front 119

What is a partial foot prosthesis?

Back 119

Front 120

Exoskeletal prosthetic device

Back 120

Made of hard, shiny plastic. Obvious external hardware at knee joint. Most durable cover, but least cosmetic. Most commonly used as training leg prior to final prosthesis.

Front 121

Endoskeletal prosthetic device

Back 121

Uses a central metal shank covered with soft plastic or foam rubber "skin-like" substance. More natural appearance. Easier to adjust. Most commonly use as final prosthesis.

Front 122

What is the purpose of reliefs and build-ups in prosthetic limbs?

Back 122

Reliefs are concave surfaces that allow decreased pressure over bony areas

Buildups are convex surfaces that allow increased pressure to more tolerant areas, such as muscle, tendons, and less prominent bony areas

Front 123

Quadrilateral containment (TFA)

Back 123

Lower posterior and medial shelf for ischial tuberosity and gluteals, higher lateral and anterior wall to direct forces to the posterior.

Front 124

Ischial containment (TFA)

Back 124

Narrower med/lat borders, weight is shifted to med/lat sides and distal limb instead of ischial tuberosity

Front 125

Vacuum suspension

Back 125

Removes all air molecules between liner, limb and socket - Allows consistent shape of limb, good for would healing, decreases shearing forces of movement, assists proprioception

Front 126

Cuff (prosthetic attachment)

Back 126

Leather strap that surrounds the distal thigh

Front 127

Corset prosthetic attachment

Back 127

Leather or flexible plastic attachment that laces up the thigh. Can be problematic due to pressure atrophy

Front 128

Distal pin prosthetic attachment

Back 128

Liner has a pin attachment that locks into place on prosthesis

Front 129

Suprochondylar brim prosthetic attachment

Back 129

Medial and lateral edges extend above the femoral epicondyles; also uses removable medial wedge.

Front 130

Supercondylar/suprapatellar brim prosthetic attachment

Back 130

Also extends anteriorly above patella - good for short transtibial amputations

Front 131

General acute care bed exercises for TKA:

Back 131

Immediatepost-op ex: GS, QS, SAQ, HS, SLR, hip abd, AP;(requires AAROM for SAQ, SLR, abd,& HS initially)

Front 132

General acute care bed exercises for posterior THA:

Back 132

If posterior approach, NO SLR with bed exercises

Immediate post-op ex: GS, QS, SAQ, HS, hip abd, AP; (requires AAROM for SAQ, abd, & HS initially)

JointCamp= standing mini-squats with RWx,4-way standing SLR with affected side, standing HS curls, standing heel raises,step-to’s on4 inch – 6 inch step

Front 133

General acute care bed exercises for anterior THA:

Front 134

General acute care bed exercises for spinal surgeries:

Back 134

Transfers - log roll

Ambulation as frequent as possible with assistance, RWX as needed

NO SLR, bed ex progressed to standing

Front 135

What is the typical length of stay for a TKA?

Back 135

D/C usually 3-5 days to home or subacute rehab

Front 136

What is the typical length of stay for a THA?

Back 136

D/C usually 3-5 days to home or subacute rehab

Front 137

What is the typical length of stay for spinal surgeries?

Back 137

D/C usually 2-5 days - may require subacute rehab if not yet independent with self care, transfers and ambulation

Front 138

When should you recommend subacute rehab placement for a patient who had elective orthopedic surgery?

Front 139

What is the PRE-op procedure for elective surgeries?

Front 140

What is the POST-op procedure for elective surgeries?

Front 141

COG

Back 141

• Just anterior to S2 (or 55% of height from ground up)
  
• undergoes a natural rise and fall of approximately 2" when walking
• undergoes a natural lateral shift of 1 3/4" when walking

Front 142

What are the 6 gait determining factors?

Back 142

Pelvic Rotation

Pelvic Tilt

Pelvic Lateral Displacement

Knee Flexion

Hip Flexion

Knee and Ankle Interaction

Front 143

SACH foot

Back 143

Sold Ankle Cushioned Heel; most commonly prescribed - comes in many sizes and angles for use in many shoes

Front 144

SAFE foot

Back 144

Stationary Attachment Flexible Endoskeleton; Allows some med/lat mobility for stability on uneven surfaces - more expensive and heavier than SACH

Front 145

What are some joint knee options for prosthetic limbs?

Back 145

Axis system (flex/ext or flex/ext/rotation)

Friction Mechanism (modified speed of motion)

Extension aid (elastic bands pull knee into extension)

Mechanical stabilizer (manual lock into extension, delayed flexion)

C leg

Computerized leg (expensive, highest quality of mobility)

Front 146

Common post-surgical amputation complications?

Back 146

Infection

DVT

Neuroma

Front 147

Sample bed exercises after amputation?

Back 147

Positioning - avoid hip and knee flexion contractors - position pt in prone, no pillow in supine

Prone/sidelying hip extension

Supine/sidelying abduction

Supine hip flexion

Sidelying adduction

SAQ (transtibial)

Glute squeezes

Quad sets

Hip rotation stretches

Front 148

Shoulder in Sling Scenario

Front 149

THA with hip precautions Scenario

Front 150

TKA with Knee Immobilizer and CPM Scenario

Front 151

TTA and TFA Scenarios

Front 152

CABG Scenario

Front 153

COPD Scenario

Front 154

Lumbar Brace Scenario