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41 Cards in this Set

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Conventional tens


HZ and freq



90-130


50-80


Acute pain

Acupuncture

1-4


~200


sub/ chronic

Early mobilisation for MI, DVT and Pulmonary embolism.

MI is death of the myocardium


DVT is when a clot happens in the veins


Pulmonary embolism is when the clot travels to the pulmonary arteries (serious life threatening)



Phase 1 cardiac rehab:

Assessment, education, Stair assessment, walking and mobilization.

P2CR, P3CR + P4CR

2) 2-6 weeks, increase of activity


3) Structures exercise training + cont educational support


4) Long term maintenance

Factors contributing to exercise intolerance in COPD patients

Ventilatory limitation, respiratory muscle dysfunction, skeletal and cardiovascular muscular de-conditioning and dysfunction, impaired gasseous exchange, demotivation.

Components of a pulmonary rehab session?

Must - LL endurance exercises


Ideally - LL strength, UL endurance + strength


Consider - Flexibility and balance

How does positioning work?

Mechanical advantage for the diaphragm


Abdominal contents increase curvature of the diaphragm allowing it to contract more effectively. Supports the arm and shoulder girdle so the accessory muscles can function better.

How to reteach breathing?

Get patient into a suitable position


place hand on upper abdomen and say you should feel the hand raise.


encourage


in through nose

blow as you go

breath out on exertion

pacing

timing with activity - in for 2 steps out for 3

purse lipped brathing

splints open airways but increases wob

optimal stretching

39 to 40 degrees


Specific adaptation to imposed demands (SAID)

Appropriate stretching

static, low force, long duration


minimum 10 minute routine


hold for 30 seconds, 2-3 stretches per muscle group


stretch to point of pain

Principles of rehabilitation exercises

SORR FITT


SAID (specific adaptation to imposed demands)


overload


reversibility


recovery


FITT

To increase lung volume or VQ matching

Side lying with affected side upper most.

ACBT for atelectasis

BC, then 3-4 TEE (breath in your favorite smell) - Hold 1 2 3 and release - Sniff

Define myotome and how are they tested?

A myotome is the group of muscles that are innervated from a single spinal nerve root


Assessed using isometric tests.

Tens letters

Acupuncture is the first one, conventional is 2nd

Acute and sub acute breathlessness is treated by...


Chronic breathlessness is treated by...

Acute is positioning...


sub acute is breathing re education...


chronic is pulmonary rehab.

Huff from mid to low and high to low will clear...

mid to low clears peripheral airways


High to low clears proximal airways

FET vs cough?

Coughing can create high pressure in the lungs which could lead to further lung collapse


Cough has been said to be equally effective but requires more effort so FET is better.

Standing a high tone patient

Inhibit all problems of flexed body from the start so bring them up in normal allignment


Hip and knee extension and trunk


No rolling of foot so someone at foot


Bring hip behind patients hip


Foot person goes from foot and knee to knee and foot


prevent snap back knee with knee

Standing a low tone patient

Low tone may be flexed to side. Patients tend to bear on unaffected side to feel safer. Struggle to co-ordinate movements (snap back knee with hip retracted or knee buckles).


Need two helpers, one on other side and one on floor. One on side keeps central alignment.


If theres not enough extension you can laterally rotate the arm or move center of chest. tapping muscle or stroking helps. must explain why you are slapping or stroking.


On the way down they will lack eccentric activity so do it slow.

Rotation

Parkinsons patients are very rigid in trunk.


patient on bed, reach across with hand for upper trunk on lower trunk rotation. do this twice on each arm.


Then do upper trunk static with lower trunk by moving knees over to one side. Twice each side.


Opposite sides lower and upper twice.


Patient sitting. Get extension and anterior tilt using stroking and slapping.


Reach with right hand over to physio hand and other way x2.


Put into functional activities.


Progress into standing.


Progress to end of base of support.

Stretching

For calf


Bring hand to bottom of Achilles use forearm against foot to stretch.


Progress to self stretching


One to another to both


For hip flexors


Possibly lie prone in day to day if he can


Legs are heavy so take care of back when lifting


come from behind and bring hip back, ensure to stabilize from hip to stop back roll. Remember rec fem is 2 joint so you shouldnt have too much flexion in knee.


At home take leg over side of bed and this will stretch.

Facilitation of first step

Swing outwards, horse shoe and step.

Preparation of foot for standing

To see equilibrium reactions in foot you can ask patient to stand on one foot and see the muscles ability to adapt.


Ensure all points of foot are on the floor other wise to stretches or give sensory input to the foot.


Use your leg as BOS for patient, ensure allignment is good, maybe a second person. Roll foot back into dorsi flexion and stabilize calcaneus. Maintain the alignment and go back into dorsi flexion. Thigh is rounded so it changes the base of support.


Depending on which muscle is tight, stretch it while giving contact to floor.


Use a football or any moving surface under the foot, ask patient to think about alignment. Take foot into dorsi flexion and plantar flexion while keeping foot on ball.

Facilitaion of full gait

Maybe need 3 therapists. possibly 2


One to transfer weight from one to another and one to do hip, knee and ankle.


If there was 3, one on hip and knee, one on knee and ankle.


Take ankle off then lock knee and move hip forwards.

Facilitation of stance phase

Stance starts with heel strike with leg forwards


Need 2 people


Quads support and hip (side) as they move forwards. Squeeze quads and hips.

Swing phase

Starts from leg at back


Feet planted on floor.


Facilitate dorsi flexion and them allow to be in readiness for stance. Dont let patient go into inversion. Ensure fingers are out of the way.

MTS of the hand

MTS is a 5 stage process


stage one is massage


stage 2 is passive movements


stage 3 soft tissue mobilization


stage 4 is sensory input


stage 5 is functional pattern of movement




stroking hand, fingers, thumb, forearm. kneading for high tone.


passive movements of joints of fingers and thumb, ensure its the right joint. do wrist too and go 90 degrees to muscles stretched.


do muscles of hand, moving them out. do extensors and flexors too.


put towel into hand asking patient if they can feel it. Work specifically on fingers and thumbs. Maybe use own hand nail. Maybe use a ball and try to squeeze.


Do hand to grab for functional



Early stage balance re education

Always have an extended trunk with anterior tilt


physio goes behind and pushes hips forwards while assistant help on upper body as needed. May need to do this for a while until patient can hold. Move patient from ant to post pelvic tilt so you know the patient can do it.


Lateral pelvic tilt. Put patient arm on shoulder, if you lift pass 90 you encourage extension of lumbar spine. Guide patient over from hip with minimal movement. Keep stroking to keep extension then do sale on other side with assistant.


Do arm movements, this raises and lowers COG and gives equilibrium reactions.


Do righting reactions for lateral movement, tilt until head starts to move towards center while stroking side muscles. do both sides.


Do arm movements and get patient to reach out to target to move COG further.

Patient assisted transfer

Bed height has to be slightly higher than surface they are going to. Chair should be almost 90 degrees but facing patient. Get patient to grab chair, they swing around and sit. Helper behind patient. Need to be facing patient and be able to swing around. Have one foot facing patient and one foot facing chair. Tell patient to reach across to handle of chair farthest away, move across. Physio moves bottom round.



Stand and step around transfer

Always go to lower height if possible. Be standing with one foot facing patient and one foot facing bed. Leave enough room between chair and bed for assistant. Take hands across patients back with assistant, ready, set and stand. Step slowly around and step back till you can feel the bed, reach down and sit, support from behind.


Infection control issues can be balanced against patient needs.

Chest wall shakings

Stand behind, On exhalations start shaking and go to function residual volume.

Late stage balance rehabilitation

Aim is to take them to edge of base of support to see maximum activity in righting reactions. Start with hand, go to light objects then heavy.


Ask to reach across to a far target while physio supports and change height of reach go far enough to be on edge of base of support. Start on just reaching for hand, then do same but with aim of grabbing object at the end. Always be able to stop the patient falling. For heavy objects patients can use two hands which will be harder because they cant use other arm for balance.


For saving reactions take someone through righting reactions until they loose it and do the saving reaction. Controlled decent until they can feel the saving reaction in different directions. Then the physio can slowly move arm against patient with a slight push, eventually speeding up the speed of the push.

Ultrasound

Contraindications?


Helps soft tissue injuries - pro inflammatory


Ensure machine is safe to use, check cables, sticker of cable and machine. Do skin sensation (hot and cold) and contraindications.


Turn the dial on the right to activate ultrasound.


First line is mhz Superficial lesion is 3mhz deep is 1mhz


2nd line is pulse duration. Acute is 0.2, sub actute is 0.4 chronic is 0.8


next setting is time, move to 2.5 minutes.


next is watts/cm (acute 0.1-0.3, Sub acute 0.2-0.5, chronic is 0.3-0.8)


ensure gel is on machine and patient before the machine starts.


Muscle is vascular and has high water content so US will not help until scar tissue forms.


Working on the principle of 1 minutes worth of ultrasound per treatment head area, the total time taken to treat the lesion will be (1 minute) x (number of times the treatment head fits over the lesion) x (the pulse ratio) which in this instance = (1) x (1) x (5) = 5 minutes.

MTS of the foot

Have patient in seated position, with 2nd physio to support if needed.


Talocrural > mid tarsal > interphalangeal


One hand into medial arch other under and under lateral border, rest foot on physio leg while sitting.

Late balance rehab

Start from standing


Use mat on floor and have two physios. Ensure neutral posture.


Pass ball from hand to hand not thrown, increase distance and add multi directional. add speed. Do throwing.


Stronger leg goes on trampoline first and physio either side, hold hand and cross over patients back to help on. Do the ball on the trampoline. To get off keep arms behind patient with other physio and step off with weaker leg.


For saving take patient weight across and then tell them they can step across when they feel it. progress speed and move to nudge.


For forwards take pelvis towards physio then forwards.


Rhythmical stabilization challenges the core to resist the movement from gym ball. Put ball right under knee. Move ball forwards, back and lateral. Patient must understand to resist. Do movements with patient resisting. Make sure they dont compensate through head and arms.


To use ball sitting, put both arms on ball and roll ball forwards and back, ensure straight back. Increase range on confidence and add direction.


Do standing hands on a plinth, standing hands on balls side by side plinth.

Sliding board transfer

Aim is to make transfering easier.


Chair almost 90 but facing patient.


Patient slowly moves bottom onto board and around into chair.


Patient has to lift, not slide. Ensure fingers are not trapped under board.


Patient ends up sat in chair, and physio and assistant pulls board out. Bed should be higher than chair.