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59 Cards in this Set
- Front
- Back
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What is the purpose of manual ROM? |
To increase motion at a specific join |
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Why would a PT/PTA need to perform manual ROM on a patient and *what is this called? |
*Indications
-If the patient is unable to complete full joint motion by themselves (could be due to surgery, weakness, altered mental state, etc.) -When new movement patterns need to be taught -To begin initial muscle activation |
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What are conditions under which you should not perform manual ROM on a patient? |
*Contraindications
-Similar to those for measuring joint ROM -Recent fracture -Pathology that may cause bleeding into the joint or altered joint integrity -Osteoporosis -Recent surgery with ROM limitations/precautions -Patient's current pain status - when do you push through the pain? |
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What is arthrokinematic movement? |
(Also known as accessory motion)
-Movement that occurs between the joint surfaces and is not visible to observing eye. -Roll, slide/glide, spin |
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What is the convex/concave rule? |
1. If a concave surface moves on a convex surface, then the roll and glide occur in the same direction.
2. If a convex surface moves on a concave surface, then the roll and glide occur in the opposite direction. |
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What are the different joint ROM activities? |
-Capsular mobilizations -Oscillations -Soft tissue stretching -ROM itself |
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What are capsular mobilizations? |
-Mobilizing a joint capsule to cause an overall effect in a specific direction of ROM for that joint. -These are accessory mobilizations -Typically follow the convex/concave rule |
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What is oscillation? |
Rhythmic movement of the joint and capsule to promote relaxation of the patient and the tissue |
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Grade 1 mobilization: |
-Small-amplitude oscillation parallel to the joint surface at the beginning of the range
-For pain reduction |
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Grade 2 mobilization: |
-Slow, large amplitude oscillation parallel to the joint surface within the free range
-For pain reduction and does not move into resistance or limit of range |
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Grade 3 mobilization: |
-Slow, large amplitude oscillation parallel to the joint surface from the middle to the end range
-To increase mobility |
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Grade 4 mobilization: |
-Slow, small amplitude oscillation parallel to the joint surface at the limit of range
-To increase mobility |
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Grade 5 mobilization: |
-Fast, small amplitude, high velocity, non-oscillatory movement parallel to the joint surface beyond pathological limitation of range
-Used when resistance limits movement in the absence of pain |
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What mobilizations can PTAs perform? |
-Grades 1 and 2 -Can do 3 if trained and experienced. |
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True or False:
Mobilization/manipulation of the spine CANNOT be performed UNLESS prescribed by a physician licensed to practice medicine in the state of NC. |
True. |
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True or False:
A PTA can perform spinal or peripheral joint mobilization/manipulation. |
FALSE.
The APTA states that spinal or peripheral joint mobilization/manipulation should only be performed by a PT. |
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Moving the joint through its physiological ROM and typically beyond what the patient can do themselves is called: |
Passive ROM or Active Assisstive ROM
Will typically do end range stretching with these by taking a joint to the end of the available PROM and hold to promote tissue relaxation and move beyond this point |
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How do you get the patient to relax? |
-Deep breathing -Visualization -Engage in conversation -As the PTA, must learn to sense when a patient is relaxed vs. guarded |
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What should a patient expect following manual ROM treatment? |
-Soreness -Improved freedom of motion -Ecchymosis (bruising) -Recommend heat or ice |
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How would you educate the caregiver, if the patient has one? |
-If the caregiver is able and comfortable doing so, teach them to perform ROM techniques that may be beneficial.
-Review what they may feel as they are moving the patient and what to expect following the treatment. |
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What should you document when performing ROM activities? |
1. Joint mobilized/ranged 2. Type of mobilization and direction of mobilization or ROM 3. If measurements were taken before and after to document benefit 4. Patient response to treatment |
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What is continuous passive motion (CPM)? |
-Passively moves a joint through one plane of motion in a continual manner
-Most often used post-operatively or post-traumatically
-Can also be used prophylactically |
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What is the purpose of CMP? |
-Decrease joint stiffness -Increase ROM -Promote healing of joint and soft tissues -Prevent scar formation/capsular adhesion -Reduce edema, clear hemarthroses -Promote aligning collagen along plane of force/movement -Improves tensile strength of tendons, allografts, and skin -Pain reduction |
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What are the goals of CPM? |
-Increase joint ROM -Improve joint nutrition -Stimulate remodeling/regrowth of healing tissue -Reduce post-op edema (elevation also assists with this) |
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What are indications for when CPM is needed? |
-Joint stiffness or patient with history of early stiffness/scarring -Total joint replacements, meniscal repairs, ACL reconstruction -Acute fx -Patient who has little support/assistance at home to assist with home exercise ROM -Any injury in which early AROM would be contraindicated but joint stiffness needs to be prevented |
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What are the precautions for using CPM? |
-Don't set motion parameters too high -Watch for increased effusion or signs of localized bleeding -Patient who is insensate - cannot verbalize if device is too tight or pain is to great -Compromised mental status |
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What are contraindications for using CPM? |
-Unwanted joint motion -Overstressing the joint -Unstable fracture -Paralysis with spasticity -Uncontrolled infection -DVT present |
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Procedure and protocol for using CPM: |
1. Check the device prior to donning 2. Make sure replaceable pads have been replaced/sanitized 3. Adjust the length of the proximal and distal carriages prior to donning 4. Place the extremity in the CPM and line the joint line up with the hinge of the CPM 5. Make sure the extremity is in neutral |
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Setting treatment parameters: |
1. Give the patient the hand-held control (kill switch) 2. Set the ROM as prescribed 3. Set the speed (cycle time or cycles per hour) 4. Instruct patient how to increase the ROM 5. Instruct patient and caregivers in inspecting for pressure-related issues 6. Check patient for pressure-related issues as well as DVTs |
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What is the CPM protocol for a TKA? |
-Day of surgery: CPM is set at 100 deg. flexion in recovery and continued for 4 hours -POD #1: increase CPM by 10 deg. or more if tolerated -Continued above POD #2-5 until patient achieves 100 deg. AROM or discharge from the hospital
**Varies from person to person** |
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What instructions would you give for the patient and/or caregiver upon the patient going home after surgery with CPM? |
--Send them home with written instructions!!! -Review set-up and adjustment of parameters -Wear time -Donning and doffing properly -Inspecting for areas of pressure |
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How to document CPM usage: |
-Joint on which CPM was used -Days to post-op -Settings and parameters used -Patient tolerance -Skin/limb integrity -Patient/joint response |
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What were the common themes of massage used in ancient cultures? |
-Used supplies available in nature -Involved exercise -Balance nature's forces -Balance the mind, body, soul |
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What did massage firstly involve? |
Squeezing tissues |
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What did massage initially treat?
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Club feet or diseased body parts
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History that fed into Western massage: |
-Asian countries: chi (life energy like when static electricity lights up in the dark; a person's aura - electrical pathway), shiatsu massage, accupuncture/accupressure -India: Ayur Veda gave rise to infant massage in the U.S. -Greece: sports massage -Rome: Roman baths similar to today's gyms -Turkey: Turkish baths and more aggressive bodywork |
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Who coined the terms effleurage, petrissage, friction, tapotement, and vibration for massage? |
Johann Georg Mezger (Amsterdam) |
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What gave rise to Swedish massage? |
The Swedish movement cure |
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When did massage treatment start being used with physical therapy? What types of massage were used? |
-The early to mid 20th century
-Swedish massage was used with hydrotherapy and diathermy (type of wave pattern)
-Sports massage |
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In the second half of the 20th century, what aspects of massage came about in the U.S.? |
-mind-body connection, emotional and spiritual connection
-massage and exercise, Tai-Chi, accupuncture |
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How is massage viewed and used today? |
-It is considered an alternative and complimentary treatment to traditional medicine |
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Procedures for administering massage: |
-Must maintain professionalism given the intimate nature of massage **Proper draping throughout communication** -Patient-therapist relationship and gender issues; seek permission and maintain confidentiality -Equipment -Mediums to assist in delivering massage; inquire about patient allergies; be cautious of scents -Dim light and adjust room to appropriate temperature
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What are the therapist body mechanics? |
-Bring the patient to you -Use assisting tools - elbows! -Maintain erect posture -Use large muscle groups -Put weight through proximal joints -Avoid hyperextension of any joint |
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Pressure, rhythm, and pacing: |
-Begin superficially and work in deeper -Strokes are typically distal to proximal; venous return and lymphatic flow (light touch) -Complete strokes along the fiber alignment of muscle and fascia
*Exception: cross friction or stripping techniques -Remeber muscle fiber architecture |
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What are the effects of massage? |
-Skin -Fascia -Muscles -Skeletal -Nervous -Endocrine -Immune/lymphatics -Digestive -Mental/emotional |
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What is rolfing? |
To educate the body to have better alignment within gravity. Technique of training works tissue to realign the whole body |
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What are indications of when massage would be needed? |
-Lack of muscle flexibility or presence of tension -Poor postural alignment -Guarded movement -Joint stiffness -Fascial restrictions** |
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What are the contraindications/precautions of massage? |
-Avoid major arteries -Note abnormal structural abnormalities of the pt -DO NOT massage over active DVT -Think skin or easily bruises -Active sickness -Area of acute trauma or active bleeding -Patients with cardiac or vascular conditions -Hypo or hypersensitive patients -Immunocompromised pts -Be aware of medications the pt is currently taking -Osteoporotic -Skin allergy or sensitivity -Low blood pressure |
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What should you assess prior to treatment? |
-Joint/soft tissue laxity and flexibility
-Pt presentation on day of treatment |
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What is effleurage? |
Large, prepatory stroke |
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Compression and rolling is what type of massage technique? |
-Petrissage |
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What is friction/cross friction? |
Deeper rolling of one tissue over another |
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What type of massage technique involves percussion? |
Tapotement |
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Other specific strokes and techniques: |
-Vibration - stimulate sensory receptors and promotes relaxation -Touch without movement - promotes relaxation, ending stroke; reflexology, trigger point work -Myofascial work - John Barnes -Trigger point work - Janet Travell -Manual lymph drainage -Reflexology -Accupuncture, accupressure -Instrument assisted soft tissue mobilization (ASTYM, Graston) |
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How long does a classic Western massage last? |
30-90 minutes (average of 60 minutes) |
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What is the order of techniques of Western massage? |
-Begin with patient prone or supine -Open with effleurage -Compression -Transition into petrissage -Friction, vibration, or deep pressure if needed -Tapotement followed by passive touch to end
*Complete all techniques in one area before moving onto next -maintain touch between techniques |
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What are special populations that massage can include? |
-Prenatal -Baby massage -Sports massage -Massage for the terminally ill |
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What are types of massage tools that may be used? |
-Trigger point therapy tool -Knobbler -Massage stick -Instrument-assisted tools |
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How is massage documented? |
-Body part(s) treated -Type of techniques utilized -Length of treatment -Patient tolerance -Patient response |
