T&p Exam Ii

Front 1

PNF has 6 objectives:

Back 1

to increase strength
to increase flexibility
to increase ROM (applied passively, assisted, actively, or with resistance)
to increase coordination
to increase balance
to decrease pain
*used in therapeutic exercise

Front 2

GOALS:

Back 2

restore of enhance the postural response and or normal pattern of motion in a functional manner
direct - focusing on target muscle
indirect - more related to the synergists or antagonist muscle group

Front 3

PNF is based on 3 principles:

Back 3

- successive induction - contraction of one muscle followed by its antagonist. e.g. contract stronger extensors to warm up before using weaker flexor group.
- reciprocal inhibition - contraction of one muscle while its antagonist is relaxed, allowing a joint to move. e.g. actively contract biceps to inhibit triceps.
- process of irradiation - is when maximal contraction of a muscle recruits the help of additional muscles. e.g. for a stroke pt return happens proximal to distal, so facilitate movement at shoulder to get some overflow into the hand.

Front 4

Basic Levels of Progression:

Back 4

1. Mobility – in a gravity-reduced position we learn the movements
2. Stability – learn how to statically hold a position against gravity
3. Controlled mobility – hold a position and moving against gravity
4. Skill – refined movement

Front 5

Agonists & Antagonists

Back 5

Agonists - directions that is being performed by that muscle
Antagonists - direction that is being performed in relation to the opposing muscle

Front 6

Main Components of PNF:

Back 6

- flexion or extension
- toward or away midline
- rotation
*based on 3 dimensions - not cardinal planes

Front 7

PNF Diagonal 1 - Upper Extremity (D1)

Back 7

D1 Flexion - flexion/adduction/external rotation with wrist & finger flexion/RD (start in extension position)
D1 Extension - extension/abduction/internal rotation with wrist & finger extension/UD (start in flexion position)

Front 8

PNF Diagonal 2 - Upper Extremity (D2)

Back 8

D2 Flexion - flexion/abduction/external rotation with wrist & finger extension/RD (start in extension position)
D2 Extension - extension/adduction/internal rotation with wrist & finger flexion/UD (start in flexion position)

Front 9

D1 Analogy
D2 Analogy

Back 9

D1 F - reaching across to grab seatbelt
D 1 E - pushing something down & away from you
D2 F - “Y” of YMCA song
D2 E - buckling seatbelt when riding shotgun

Front 10

PNF Diagonal 1 - Lower Extremity (D1)

Back 10

D1 Flexion - flexion/adduction/external rotation with DF & IV (start in extension position)
D1 Extension - extension/abduction/internal rotation with PF & EV (start in flexion position)

Front 11

PNF Diagonal 2 - Lower Extremity (D2)

Back 11

D2 Flexion - flexion/abduction/internal rotation with DF & EV (start in extension position)
D2 Extension - extension/adduction/external rotation with PF & IV (start in flexion position)

Front 12

D1 LE Analogy
D2 LE Analogy

Back 12

D1 F - juggling a soccer ball on the side of your feet
D1 E - reaching back to stop a soccer ball or letting one leg hang off a bed
D2 F - dog peeing on fire hydrant
D2 E - dance, swinging foot in front across your body

Front 13

Line of Movement

Back 13

rotation is the initiating movement, then the other 2 components are initiated.

Front 14

Isotonic/Isometric/Eccentric Defintions

Back 14

Isotonic - tension remains unchanged and muscle length changes
Isometric - muscle length remains unchanged
Eccentric - muscle length elongates

Front 15

Stretch

Back 15

stimulus - muscle responds with greater contraction force when put in a stretched position due to increased surface area
response - quick stretch elicits a response when placed beyond point of tension

Front 16

Manual Resistance

Back 16

should demand sufficient resistance
allow full ROM to be completed
shouldn’t break patients movement
shouldn’t elicit Valsalva Maneuver

Front 17

Joint Facilitation

Back 17

traction - separating the joints (promotes mobility)
approximation - applying a weight bearing force on joints via compression (promotes stability)

Front 18

Agonist Contraction

Back 18

HR or CR done, then pt moves limb into new range actively. Called HR-AC or CR-AC.

Front 19

Rhythmic Initiation

Back 19

sequence passive - active-assisted - active - resisted (make sure they are doing correct movements hands off. Used for patients having difficulty initiating movement (e.g. Parkinson’s patients). Allows the patient to understand the proper movement that is expected of them.

Front 20

Hold-Relax

Back 20

directed towards “tight” antagonist, isometric. (E.g. pt holds antagonist isometric, then PT passively moves pt further in range). “hold, hold, push into me”

Front 21

Contract-Relax

Back 21

directed towards “tight” antagonist, isotonic. (E.g. pt performs isotonic contraction of antagonist against resistance from the PT, then PT passively moves them further into the range). “push, push, push”

Front 22

Testing Stability

Back 22

- Alternating Isometrics (AI) – PT gives resistance alternating F/E, add/abd, ER/IR to get pt to do isometrics of m across the jt
- Rhythmic Stabilization (RS) – next step after AI, promotes co-contraction of m around a jt. PT provides stimulus similar to AI but less predictable. pt has to be ready for anything.

Front 23

Testing Strength

Back 23

- Repeated Contractions (RC) if want to work on shoulder flexion, start in D2E, pt actively brings it into D2F (can be against resistance), relaxes, passively brought back down to D2E by PT, repeat. (apply resistance in one direction repeatedly)
- Agonist Reversal (AR) – aka slow reversal (SR), start c antagonist pattern first, then perform agonist pattern. Successive induction concept. (e.g. resist F, then resist E. Start c antagonist first to warm up the agonist/apply resistance in both directions)

Front 24

Purpose of Circuit Training

Back 24

Composed of aerobic and resistance training with little rest in between sets (not suitable for bulking up)
targets fat loss
builds muscle strength
increases heart and lung function
used to strengthen 8-12 muscles

Front 25

Type of Programs

Back 25

- Sparticus Workout - consists of 3 sets of 10 exercises each with 2 minute break in between each set and 15 second break in between each exercise (constantly changing muscle activation with short rest periods, burning 741 calories).
- P90x - includes 12 exercises that prevent the body from plateauing due to constantly “confusing” muscle.
- Insanity - consists of 10 high intensity work outs that could last up to 80 minutes long (burns 1000 calories per hour).

Front 26

Sets & Reps

Back 26

2 to 3 sets
8 to 12 reps
90-100% of 10 RM or 40-50% of 1 RM
*involve high repetitions, low intensity

Front 27

Experiments on COPD and TBI Patients

Back 27

- COPD patients - 2 week training period increases UE & LE forces and 6 minute walk distances
- TBI patients - 12 weeks of exercise sessions lasting from 1-2 hours each does not reduce weight and change body fat percentage

Front 28

Experiments on CAD and Stroke Patients

Back 28

- Cardiac History patients - circuit sessions involving 40-60% of 1 RM for 6 exercises (30-60 seconds of rest in between sessions) - proved to only be affective for phase II CAD patients.
- Post-stroke patients - experimental group (strengthened LEs) experienced greater gains in locomotion then the control group (strengthened UEs).

Front 29

Experiments on Diabetes Patients

Back 29

result in increases in lean body mass, lowered % body fat, strength gains, LDLs decreased (no changes in total cholesterol, triglycerides, or fasting blood glucose levels).

Front 30

Specific Gravity of H2O

Back 30

1 gm/cm squared

Front 31

>Specific Gravity
<Specific Gravity

Back 31

?

Front 32

Center of buoyancy is equal to:

Back 32

center of gravity

Front 33

Hydrostatic Pressure

Back 33

pressure of a fluid is exerted on an object equally at a given depth (Pascal's Law)
*increases with depth because pressure increases

Front 34

Viscosity

Back 34

resistance to adjacent fluid layers
*increase with speed of movement

Front 35

Physiologic Response to Immersion

Back 35

- centralization of peripheral blood flow
- immersion to diaphragm raises heart volume by 130 mL
- increases intrapulmonary blood volume
- decreased vital capacity
- increased SV (35%) and cardiac output (32%) with immersion of neck

Front 36

Thermoneutral temperature

Back 36

- 34 degrees Celsius
- most pools range from 25-35 degrees Celsius
- >40 degrees Celsius changes the pH of the water

Front 37

Contraindications of Aquatic Therapy

Back 37

- excessive fear of water
- open wounds, rashes, infections
- incontinence
- tracheotomies
- cardiopulmonary insufficiencies/impairments

Front 38

Age of Onset for OA/RA

Back 38

OA >40
RA 15-50

Front 39

Progression of OA/RA

Back 39

OA - slowly, months/years
RA - fast, weeks/months

Front 40

Dx of OA

Back 40

- loss of cartilage and narrowing of joint space
- pain in weight bearing position
- swelling

Front 41

Dx of RA

Back 41

- morning stiffness that lasts at least 1 hour
- at least 3 swollen joints = wrist & hands for > 6 weeks symmetrically
- Rh factor positive
- nodules
- x-ray changes

Front 42

Manifestations of OA

Back 42

- bone spurs with articular cartilage, distal fingers

Front 43

Manifestations of RA

Back 43

- more proximal joints affected

Front 44

OA Joint Involvement

Back 44

- unilateral, no pattern

Front 45

RA Involvement

Back 45

- smaller, swelling, symmetrical

Front 46

OA & RA Signs/Sx

Back 46

OA - pain in weight bearing, no movement, pain in joint, no systemic signs
RA - stiffness despite activity, pain anywhere, fatigue, weight loss, night sweats

Front 47

Management of RA in Acute Phase

Back 47

- patient education
- relieve pain and promote relaxing
- minimize joint stiffness with passive or active-assisted ROM
- minimize muscle atrophy using isometrics

Front 48

Management of RA in Subacute/Chronic Phase

Back 48

- same as acute phase but can ad non-impact or low impact conditioning exercises using water aerobics

Front 49

How Often Should People With Arthritis Exercise?
- ROM
- Strengthening
- Endurance

Back 49

- ROM: daily or at least every other day
- strength: every other day unless pain or swelling is present
- endurance: done for 20-30 minutes 3 x week, since fatigue is common - can be done in increments of 10 minutes throughout the day

Front 50

How Much Exercise is too Much?

Back 50

- pain that lasts more than 1 hour
- fatigue
- weakness
- decreased ROM
- joint swelling

Front 51

How do you progress closed-chain activities?

Back 51

partial weight to full body weight then resistance can be added using hand weights, weight belts, or theraband

Front 52

Plyometrics

Back 52

used to train the neuromuscular system by forcing the body to react quickly inorder to prepare for activities that require rapid starting and stopping movements: drop push ups from boxes sto floor and back on boxes/clap push-ups/hopping over line

Front 53

Two Advantages to the Athlete Because of Plyometrics

Back 53

- injury prevention
- improve performance/power

Front 54

Prerequisites to Plyometrics

Back 54

- 5 push ups
- 5 squat thrusts
- standing long jump with good landing technique
- 30 secs of continuous jumping rope
- square pattern jumping
- square pattern hopping on both legs

Front 55

PLYOMETRICS: Definition of Jump/Hop/Bound

Back 55

jump - two foot landing
hop - one foot landing
bound - repetitive landing alternating feet

Front 56

Sensory Inputs for Maintaing Balance

Back 56

- vestibular
- visual
- proprioception
- touch

Front 57

Progression of Balance Rehab

Back 57

- begin with holding position
- progress to weight shifting
- begin with bilateral activities
- progress to unilateral activities
- balance with eyes open then closed

Front 58

Concerns of Mechanical Treatment/Back Pain

Back 58

- no position can be found to relieve pain
- pain remains the same - no increase or decrease with motion
- progressive neurological signs
- patient has fused spine OR unstable spine

Front 59

Extension Exercises for LBP

Back 59

- prone at side for 5 mins and remove pillows under abdomen/hip
- prone press-up
- prone on elbows with LB in ext
- backward bending standing
- sitting in a chair and going from a slouched position to a lordotic position for 20 reps

Front 60

Flexion Exercises for LBP

Back 60

- posterior pelvic tilt
- partial curl up (not good if they have osteoporosis)
- knees to chest
- long sit and reach for toes
- squat while holding chair from behind, flexing the spine slightly in the the process

Front 61

Spinal Exercises for Stabilization Purposes

Back 61

dead bug series

Front 62

Requirements for "Home Health?"

Back 62

- take a great effort to get out of house, bed-bound, weakness
- age is not a factor, just a determinant of your function

Front 63

Severity of Tissue Injury

Back 63

Grade 1 (first-degree)
- Mild pain at time of injury or within 24 hours
- Mild swelling, local tenderness, and pain when tissue is stressed
Grade 2 (second-degree)
- Moderate (or severe) pain that requires stopping the activity
- Stress & palpation greatly increase the pain
- If the injury is to ligaments  ^jt mobility
- So much swelling and pain you can’t assess joint activity
Grade 3 (third-degree)
- Near-complete or complete tear or avulsion of the tissue (tendon or lig) with severe pain
- Stress to the tissue may be painless, palpation may reveal the defect
- A torn lig results from instability of the joint
- Avulsion fx – the separation of a bone fragment from its cortex at an attachment of the lig or tendon
*when you stress it layer, it may not be as painful as a G2 tear b/c when you pull on the G2 it will hurt, while G3 had nothing to pull on

Front 64

Management in Acute Stages

Back 64

- lasts 4-6 days
- cold, compression, elevation to decrease swelling
- gentle PROM to maintain joint mobility
- massage for circulation
- aerobic/restrictive/low intensity isometric exercises
- AROM/stretching/high intensity (strength) exercises are contraindicated

Front 65

Management in Subacute Stages

Back 65

- lasts 14-21 days
- AROM/stretching/Active exercises can begin
- PWB
- massage for circulation
- HR/CR
- controlled motion/closed chain exercises
- don't overstress tissues!

Front 66

Management in Chronic Stages

Back 66

- lasts 21-60 day
- active stretching
- progressing from single plane to multi-plane exercises
- increasing resistance

Front 67

Precautions for Rehab After Articular Cartilage

Back 67

- bigger the lesion the worst
- early ROM immediately after surgery
- FWB is delayed 8-12 weeks
- protective brace locked in extension for 4-6 weeks, during sleep for 4 weeks
- patellar fractures are not as severe as femoral condyle fractures

Front 68

Rehab Precautions for TKA

Back 68

- SLR delayed 2 weeks for cemented and 4-6 weeks for cementless
- for low intensity resistance
delay could be anywhere from 2 weeks - 3 months
- no FWB or AWB until strength in quads and hamstrings is gained

Front 69

Rehab Precautions for ACL Reconstruction

Back 69

General Guidelines:
- be more careful for hamstring grafts compared to patellar grafts
- flexion exercises
precautioned for hamstring graft/extension exercises precautioned for patellar graft

CC Exercises:
- make sure hips are pushed back when doing a full squat
- avoid cc exercises strengthening the quads between 60-90 degrees of knee flexion

OC Exercises:
- strengthen above the knee before strengthening below
- avoid oc knee extension between 45-15 degrees
- avoid applying resistance to the distal tibia

Front 70

Rehab Precautions for PCL Reconstruction

Back 70

- no resistive hamstring curls for 6-8 months
- only use low intensity if using hamstring curls
- avoid downhill inclines
- avoid activities that involve knee flexion with both feet on the ground and rapid deceleration
- postpone vigorous activities for 9 to 12 months

*in general, avoid exercises that cause posterior shear/translational forces on the tibia!

Front 71

Rehab Precautions for Meniscus Repair

Back 71

General Precautions:
- progress exercises more gradually for a central tear vs a peripheral tear (due to blood supply?)
- clicking sensation in knee = report immediately to surgeon!

Early/Intermediate Rehab:
- increase knee flexion gradually, especially after a central zone repair
- set seat on stationary bike as high as possible to prevent knee flexion
- during weight bearing exercises such as lunges/squats, do not perform knee flexion beyond 45 degrees for 4 weeks and beyond 60-70 degrees (this can place a posterior translation on the meniscus) for 8 weeks.
- avoid twisting activities
postpone hamstring curls for 8 weeks

Advanced Rehab:
- no exercises involving deep squatting, deep lunges, twisting, or pivoting for 4-6 months (> the flexion angle, > stress on meniscus)
- no jogging or running program for 5-6 months

Front 72

Precautions for Shoulder Arthroplasty Rehab

Back 72

- low number of repetitions per exercise = to prevent fatigue?
- only perform passive/assisted ROM exercises
- passive ER to neutral or less then 30 degrees (limit ER)
- when in supine, position shoulder slightly anterior to the midline so that stress won’t be placed on the anterior capsule (place a pillow/towel under arm)
- no hyperextension or horizontal abduction beyond neutral (prevent anterior capsule stress)
- maintain an erect trunk during exercises to prevent subacromial impingement of tissues
- no active, antigravity, dynamic shoulder exercises!
no resistance (strengthening) exercises
- want to promote more gradual progression of exercises for a patient with a severely damaged and repaired or an irreparable rotator cuff mechanism than a patient with a preoperatively intact cuff

Front 73

General Exercise Guidelines/Precautions After Repair of a Full-Thickness RC Tear

Back 73

- passive/assisted ROM in pain-free ranges
- only passive and no assisted ROM for 6-8 weeks if massive rotator cuff tear
- minimize anterior translation of humeral head (place towel under head, place shoulder in slight flexion/45 degrees of abduction, etc)
- remember to maintain an erect trunk when performing ROM exercises in sitting position to prevent subacromial impingement
- do not allow active shoulder flexion/abduction until patient can do so without hiking the shoulder (must strengthen tissues to prevent superior translation of humeral head upon activated motion)
- no closed chain activities for 6 weeks

Front 74

Additional Precautions for RC Tear in Relation to Exercises

Back 74

- delay progressive resistive exercises for 6-8weeks
- if supraspinatus was repaired - avoid ER
- if subscapularis was repaired - avoid IR
- if deltoid was repaired - avoid extension, adduction, horizontal adduction
- isometric exercises for at least 6-8 weeks

Front 75

Precautions for Bankart (anterior) Repair

Back 75

- limit ER, horizontal abduction, extension during first 6 weeks post-op
- if subscapularis was repaired - avoid IR
- no vigorous stretching to increase end-range for 8-12 weeks