Upgrade to remove ads
Therapeutic Interventions 342 Exam 1
Terms in this set (100)
Three indications that therapeutic exercise program is applying too much stress to patient's injury.
3. Loss of plateau in strength or ROM
What type of exercise would be indicated in early rehab process?
Sub max exercises in short bouts repeated several times a day
Example of abnormal biomechanics in patient who makes compensatory actions from an injury
Compensation: hamstrings or lower back pain while running as a result of weak gluteus maximus....over compensation while running causes tightness in these muscles.
What is functional kinetic chain rehabilitation?
Comprehensive approach improving all components necessary to allow patient to return to high level function.
Addresses each link in Kinetic Chain (functional strength and neuromuscular efficiency)
Three main components of therapeutic interventions in rehab?
1. Therapeutic exercise
2. Manual therapy
3. Patient education
Five typical rehab goals post-musculoskeletal injury?
1. Modulation of pain
2. Facilitation/inhibition of skeletal mm. performance
3. Decreasing inflammation and facilitating tissue healing
4. Increasing tissue extensibility (ROM)
5. Flexibility-muscle length
What is PRICE? Give example of each
∙Protection: splint/wrap, immobilize injured ankle, use crutches
∙Rest: 24-48 hrs rest prior to active rehab
∙Ice: for at least 72 hrs. post injury-decreases pain, inflammation, swelling, etc
∙Compression: use ace wrap to apply pressure to ankle (72 hrs continuous compression)
∙Elevation: gravity helps prevent blood from pooling in extremity. Elevate ankle as much as possible for 72 hours post injury.
The mind's attempt to teach the body conscious control of a specific movement is called_____
Restoring postural control involves integration of what three things?
Muscular forces, neurologic sensory information, biomechanical information
Plyometrics relies on a _______ to facilitate a subsequent concentric contraction
Quick eccentric stretch
Five factors to consider prior to Return to Play?
1. Physiological healing constraints
2. Pain status
3. Range of motion
5. Neuromuscular control
3 main categories of therapeutic modalities
1. Thermal-hot/cold packs, water, ice, light
2. Electromagnetic- E-stim, laser, UV,SWD
3. Mechanical-compression, traction, US, hydrotherap
_______pain can change neural pathways
untreated or chronic
FES is used in patients with...
compromised ability to activate specific mm to restrain gait, use of hand, ROM, ↓spasticity, disuse atrophy, CV decline, bone degredation
5 signs of inflammation?
4. ↑ Temp
5. ↓ ROM
Cold decreases tissue temperature which reduces...
blood flow and tissue metabolism; reduces threshold of pain by desensitizing peripheral afferent nocireceptors
What are 3 stages of tissue repair?
US increases___(a)___transport up to __(b)__ cm deep and helps in......(c)
(a) cell membrane
(c) connective tissue collagen protein proliferation and remodeling stages until it heals back to "strength of steel"
3 ways/itens to measure effectiveness of therapeutic interventions
1. Swelling (girth)
2. ROM/mm length flexibility (% goniometry, inclinometers)
3. Strength (MMT, rep max)
Five precautions/contraindications when assessing use of therapeutic interventions
1. impaired sensation
5. electrical implants
What does SOAP represent?
Subjective, Objective, Assessment, Plan
When determining rehab plan, ____(a)___, ___(b)___, nature and ___________(c)_______ must be considered
(c) stage of injury
What are the three phases of healing and how long does each phase generally last?
1. Phase1: Acute injury lasts 2-3 days
2. Phase 2: Repair Phase as long as inflammation is low
3 Phase 3: Remodeling Phase- longest phase, as long as rehab takes.
List two specific diagnoses which are examples of
Acute injury: (occur suddenly) Inflammation, swelling.
Chronic injury: (gradual pain) Tendinitis, stress fracture, compartment syndrome.
Explain a secondary injury that may occur after a primary injury by describing an example
If an individual were to fracture their patella due to a direct blow to it (primary injury). The secondary injury to that would be the inflammation and hypoxia response to the breaking of bone and very possibly some blood vessels.
Progressive controlled mobility (ROM) enhances
Scar formation, Muscle regeneration, fiber reorientation, tensile properties
What is the difference between a sprain and a strain?
- Sprains involve damage to a ligament
- Strains occur when the musculotendinous unit is overstretched or forced to contract over too great of resistance.
List at least two characteristics of the following grades of ligament injury.
- Grade I.: Some pain, minimal loss of function, no abnormal motion, and mild point tenderness; minimal joint instability
- Grade II.: some tearing and separation of ligament fibers; moderate to severe pain, moderate loss of function, swelling, and instability
- Grade III.: complete ligament rupture, extremely painful, inevitable loss of function, severe instability and swelling, and may also represent subluxation
Immobilization after a fracture is generally required for ______ weeks?
Nerves regenerate at a rate of _____mm/day
What is the difference between a subluxation and a dislocation?
- Subluxations are partial dislocations causing incomplete separation of two bones.
- Dislocations present with total disunion of bone apposition between articular surfaces requiring manual or surgical realignment.
Why might a negative stressor predispose an athlete to injury? Explain.
- May lead to lack of attentional focus and therefore more prone to re-injuring themselves - miscues tear on the playing field
- Muscle tension - causing reduced flexibility and motor coordination
List three buffers that can allay the symptoms of stress.
- Buffers allay the symptom of stress without dealing directly with what originally caused the stressor
o Progressive relaxation with or without imagery
o Aerobic exercise
o Diet modification
o Treatment of sleeping disorders
o Time management programs
5 signs of clinical depression
- Loss of appetite,
- sleep disruption,
- change in mood state,
- plans for suicide
Name three psychological Reactive Phases to injury and rehabilitation.
- Reaction to injury
- Reaction to rehabilitation
- Reaction to return or career termination
Give examples of three interventions a health care provider can do to help an athlete cope with a long-term injury.
- Avoid reasoning with anger - it cannot be challenged
o Work with the athlete to control anger, determine cause and together develop solutions
- Serve as an active listener
- Control the inner negative thoughts which are detrimental to rehabilitation
o Impact mental and physical performance
o Instill positive attitude
An efficient core allows for maintenance of what?
- Normal length-tension relationships
- Normal force couples
As well as optimal efficiency of entire kinetic chain and _______ for extremity movement.
- Proximal stability
Give an example of a lumbar spine, hip and abdominal muscle and what each does for core stability.
- Lumbar Spine: Erector Spinae group; provide intersegmental stabilization, eccentrically decelerates trunk flexion and rotation.
- Hip: Psoas muscle; works with erector spinae, multifidus and deep abdominal wall to balance anterior shear forces of lumbar spine.
- Abdominal muscles: transverse abdominal muscles, increases intra-abdominal pressure, provides dynamic stabilization against rotational & translational stress, provides neuromuscular efficiency.
Explain the drawing in maneuver.
- Drawing in Maneuver:
o Patient will maintain pressure for minimum of 10 seconds
o Monitor drawing in of the abdomen as opposed to pushing out of abdomen signaling internal oblique activation.
Briefly explain how muscle activity enhances joint stability.
- Increased joint congruency
- Provides eccentric absorption of external loads
- Increases muscle stiffness
Injury can result in damage to microscopic nerves associated with peripheral.
Muscle spindle mechanoreceptors detect______ and the rate of _______ in the musculotendinous system.
Length and Length changes
Briefly describe another mechanoreceptor and what it does?
- Articular Mechanoreceptors: Specialized nerve endings that transduce mechanical tissue deformation into frequency modulated neural signals
How do mechanoreceptors affect feed-forward control?
- Mechanoreceptors provide sensory info for thing such as stretch, pain, and pressure. Allowing the feed-forward control to plan muscular movements based on this sensory information that it receives from the mechanoreceptors.
Balance is complicated and partially dependent on inherent ability to integrate _________ and ________ input with neuromuscular control.
- Somatosensory input with vision
- Vestibular apparatus
Explain how and why you test the reflex loop?
- You can test the reflex loop by testing reflexes. This then actives the stretch reflex triggers and it activates muscles around a joint. It may result in muscle responses to compensate for postural imbalances and sways. Muscle spindles will sense a stretch in the agonist muscle and sends a signal back to and up the spinal cord, to fire up the muscles to maintain postural control.
List at least 5 activities that can improve neuromuscular control.
- Slide board exercises
- Stair Climbing
- Stretch-shortening exercises
- Unstable surfaces
- Trampoline hopping
List three ways to challenge balance during training.
- Static balance training- train reflex stabilization and postural orientation
- Dynamic balance training- important for patients performing running, jumping and cutting exercises. Involve displacement or perturbation of COG. Sit to stand exercises, focus on postural control. Bilateral, unilateral stances or weight transfers involved.
- Dynamic and functional types of exercise; slow to fast, low to high force, controlled to uncontrolled.
List three impairment factors (problems) which may disrupt balance.
- Forces exerted by pairs of opposing muscles at a joint to resist rotation (joint stiffness)
- Resting position and joint stiffness are altered independently due to changes in muscle activation
- Myotatic reflex is earliest mechanism for activating muscles due to externally imposed joint rotation
Example of an exercise to train Dual Task Balance?
- SL stance on an unstable surface (ie bosu ball), perform a single leg RDL.
- leaning torso parallel to ground
-keeping core tight
From least to best what is the type of research/evidence in the Hierarchy of study design.
1- Systematic Reviews
3- Consecutive Cohort Studies
4- Expert Opinion
What is EBP?
Evidence Based Practice focuses on research but also extends to other factors in clinical decision making processes.
How does it relate to EBM and PBE?
- EBP uses research found in EBM but also applies other clinical factors that EBM would not use when making program decisions.
- PBE is usually the other factor that is paired with EBM when making a program or decision. Basically if you combine PBE and EBM you are using Evidence Based Practice.
Briefly explain why flexibility is important to restore in any rehabilitation program.
- lack of flexibility causes immobilization of muscle; which is done by flexing the tissues will shorten and tighten in response.
- Immobilization can cause damage to basic functioning of muscle
- Flexibility and mobility are essential for proper healing.
Briefly explain the neurophysiological basis of stretching.
- Stretching causes proprioceptive stretch relfex, activating mechanoreceptors(which detect stretch in muscle).
- Via Mechanoreceptors, muscle spindle response is graded by rate of stretch (more stretch= more rapid loading of muscle)
- ex: During eccentric loading, muscle tension increases, triggering GTO to initiate reduction in muscle excitation.
What are the three types of muscle contractions and briefly explain when and why they are important in rehabilitation.
- Eccentric: muscle stretch reflex increases tension in lengthening muscle. Increased tension cause GTO and muscle spindle to oppose eachother= increased force production. Used in rehab to test force production with lengthening muscle fibers.
- Concentric: Muscle spindle activity is reduced with shortening muscle. In rehab this helps determine any issues with muscle during shortening and what specific areas need strengthening.
- Isometric: Full force contraction without lengthening or shortening of muscle., such as a one rep max. In rehab this contraction would be good for testing muscle strength and where there may need to be more work done to strengthen and maintain the muscle.
What other physiological adaptations of strength resistance exercises besides muscle hypertrophy are important to assist with rehabilitation of injuries?
- Strength of non-contractile structures: Tendons and ligament increase and increased bone-mineral content during rehabilitation of an injury.
- Improved oxygen uptake: Occurs if resistance/training intensity is high enough to elicit a cardiovascular response/adaptation, which would be beneficial during rehab of an injury.
- Increased metabolic enzymes: Enhances aerobic and anaerobic metabolism which keeps the patient in shape and healthy during their rehab time.
Briefly explain the rationale for functional strength training.
- Bodies work as a kinetic chain, composed of muscles, tendons, fasciae, ligaments and neural systems. All these parts work together to allow the kinetic chain function as a whole. If one of these parts isn't working properly it can alter other parts and performance.
-The functional strength training allows for optimal neuromuscular efficiency during activities, such as concentric, eccentric and isometric contractions. Most importantly, FST enhances strength, improves neuromuscular control, stabilization strength and dynamic flexibility.
Explain an example of a sports injury that would benefit more from open chain exercises during rehabilitation more than lower chain exercises.
- Basketball player with knee injury, benefits more from open chain exercises: b/c more core and joint stability.
- Open chain recruits more shear forces in specific areas, rather than a whole kinetic chain working (like a closed chain exercise does).
How does blood pressure in a healthy individual respond when monitored during aerobic exercise?
- during exercise bp goes up
- but - Consistent aerobic exercise in a healthy individual will result in an overall reduced resting blood pressure.
What is the ACSM recommendation for adults for CV exercise?
-moderate intensity cardiorespiratory exercise > 30 min/day, >5 days/wk, vigorous intensity > 20 min/day, >3 days/wk, or a combination of both.
- 20-60 minutes with HR elevated to training levels, intermittent exercise bouts (10 min) can also be used.
Why is interval training necessary when rehabilitating an athlete?
- intermittent activities involve periods of intense work and active recovery. Most aerobic sports require short bursts which can be mimicked through interval training, this also gets their heart rate up which helps keep them in shape for their sport.
What is the goal when training someone in plyometric exercise?
- the goal is to decrease the amount of time between eccentric loading contraction and concentric force producing contraction.
What is the recommended number of foot contacts for a beginning plyometric exercise program?
-Varying with exercise and intensity of exercise beginners should get about 75-100 (low intensity) foot contacts and those who are more advanced should get around 200-250 (low to moderate intensity) foot contacts.
How is functional stability provided for our joints?
- Functional stability pertains to the passive restraints on ligaments, joint geometry, active restraints generated by muscle, and joint compressive forces to provide stability for our joints. This stability is largely maintained by neuromuscular control and helps with other things like proprioception.
How can functional training decrease an athlete's anxiety about returning to sport?
- decrease the anxiety that an athlete may feel about their injury; by helping them to better understand the severity of their injury and time to heal.
- reduce any fear or uncertainty they have about the future, which allows the athlete to experience success and not be concerned about failure.
Explain how you would determine that an athlete is ready to return to play?
- have no more pain,
-normal ROM and strength
-pass the functional testing.
Allowing for a few minor mistakes, to allow them to play in their sport again.
What are some limitations to the recommendation that an athlete have a cutoff score of 14 on the FMS scoring sheet?
-increased risk of injury. Having a 14 vs a 18 on the scoring sheet can put the athlete back in action on the field or court while they are not up to their full functioning capabilities, which can lead to an additional injury in the future.
Explain how you would prepare a patient both psychologically and physically prior to applying an ice bag to a patient who suffered an acute knee sprain.
- talk through process, inform of procedure
- cold temperature with slight pressure from compression
- answer any questions they have
- clean working space
- place in comfortable position, likely with a pillow supporting injury
- compression with with either ACE wrap or ice compression pants
Explain how you would prepare a patient who has chronic low back pain prior to applying a hydrocolator pack. This should include the rationale for the intervention.
- clean working space
- lay on stomach or in comfortable sitting position.
- apply 4-5 layers of clean towels on low back.
- place hydrodollator pack (moist heat) on towels for 15-20 min.
Rational behind this:
- moist heat raises the temperature of muscle as much as 20 degrees.
- improves flexibility even more than stretching.
Briefly explain to a patient who has chronic knee edema why you are applying intermittent pneumatic compression to his knee.
-about applying pneumatic compression to his knee- due to fluid building up in his joint space most likely due to the impairment of his lymphatic vessels.
- inform that this pooling of fluid in the joint space causes a decrease in ROM and oxygen levels to the tissue, which could increase the risk of infection and compartment syndrome.
What temperature range do you need to get a therapeutic level of tissue temperature elevation?
To elevate tissue temperature:
104-113 degrees F.
Compare and contrast the use of heat versus cold as a therapeutic modality to decrease an upper trapezius myofascial trigger point.
- help relax muscles
- help decrease the rate of type 2 spindles firing, which causes trigger pain.
- decreases firing of alpha motor neurons and tonic reduction of tonic extrafusal fiber activity.
- Good to use prior to massage.
- numbs the painful area
- allows for stretch in muscle trigger point areas
- able to restore more ROM. via stretching.
Ultrasound is ______ energy.
US is applied with an applicator which produces_____ and transfers energy by _____.
2. coming out in columns directed into an area.
The number of oscillations a molecule undergoes during 1 second is the _____ of a sound wave measured in Hz.
1 MHz (goes 2-3 in deep) is ______ cycles/second.
Explain the difference between pulsed and continuous US and when you might use one over the other as a therapeutic modality?
a. Pulsed US at 20% might be used for non-thermal effects, at 50% produces very mild heating effects. This can be helpful with injuries pertaining to joints and areas with bone or thin tissue. ( acute injury, non thermal effects.)
b. Continuous US is often associated with its use for heating effects. This would increase cell membrane permeability, tissue regeneration, stimulates phagocytosis and synthesis of collagen. This would be likely used on an injury with large muscle mass, such as the quad muscles. (upper trap- continuous for more thermal effects.)
When would you use 1 MHz versus 3 MHz? Please give an example of an appropriate injury that you would treat using each.
a. To treat a deep rotator cuff injury, you would use the 1 MHz to penetrate deeper into the muscle.
b. To treat an injured MCL you would use the 3 MHz which is more superficial and would heat up quicker.
What does the acronym LASER stand for?
- Amplification by
- Emission of
Cold laser power=?
1. 60 W
2. 20 W
3. 15 W
What is the difference between a high-power laser and low power laser (LLLT)?
- High-power laser- is the class 4 laser has a greater power output and provides deeper penetration over larger areas than the LLLT laser does.
- Low-level laser Transmission (LLLT)- uses infrared lasers around 532 watts, it is a low-intensity laser "cold" laser. Because of its low intensity it can penetrate deeply into the skin and other tissues. It is also an effective way to produce analgesia and accelerate healing of a variety of clinical conditions.
_______does not require a medium through which to travel.
- Electromagnetic Waves
- Light i.e. lasers
________Does require a medium through which to travel.
Mechanical Waves (Ultra sound)
Laser power is measured in _____ and defined as _____.
- As the optical power of the laser beam
In LASER therapy, light energy is absorbed into the patient's tissue and triggers biological changes at a cellular level to provide what therapeutic effects?
- Altered nerve conduction velocity
- Increased ATP production
- Increased collagen production
- Increased macrophage activity
- decreased inflammation
- stimulation of acupuncture points.
What are at least 5 contraindications/precautions for laser therapy?
- Application to eyes
- Over areas of hemorrhage in high intensities
- Over cancerous areas
- Laser therapy should not be applied within 6 months of radiation therapy
- Due to unknown effects, lasers should not be applied to the low back or abdomen during pregnancy
- Not used over unfused epiphyseal plates
- Not administered to small children
- Patient may experience dizziness during treatment. If this occurs discontinue, if it occurs again in therapy, discontinue laser treatment all together.
Electrotherapy is stimulation to elicit or facilitate some desired therapeutic response. It can be used to activate skeletal muscle for _______, to relax skeletal muscle to ________, and to decrease _______, improve ___________
-strengthening or improving volitional movement
-facilitate functional activity
-circulation or facilitate tissue healing.
A net gain of electrodes results in a _______ charge and a loss of electrons results in a ________ charge.
An atom that has gained or lost an electron is an _____
In a simple circuit, one electrode is the ______pole (cathode), and one is the ______pole (anode). This is found in the example of a household battery. One pole has a concentration of electrons (cathode) and the other has a ______(anode). The separation of charge creates a _________ gradient. When connected, current flow between the poles. The household battery is an example of DC (direct current), which is the continuous _________ flow of current for at least 1 second.
The force created by the separation of charge may be one of_____, or repulsion and represents the electrical field. Like charges _____ and opposite charges _____.
Iontophoresis uses DC or alternating current (AC) to move ions?
- DC - direct current
The rate at which AC switches directions is termed _________ and is described with the international unit _______. AC changes direction at least one time per second. The electricity coming from the wall in your home is DC or AC? _______.
2. Hertz (Hz)
3. Alternating Current
_______represents the driving force that pushes charge and is created by the electrical field. They are created when oppositely charges particles are separated or when like charges are_________.
2. Brought closer together
The charged particles are the electrons that are moved within a powered machine, wire or our bodies. In biological systems, ______ forces are created by the uneven distribution of charged particles, resulting in regions that are more or less ____ or ____ to adjacent regions.
Give two examples of good and bad conductors of electricity both in our bodies and outside in the environment.
- Good conductors
o In the body, tissues such as muscle, nerves, and bodily fluid serve as conductors
o In the environment, copper would be a good conductor
- Bad conductors
o In the human body fat would be a bad conductor because it is an insulator
o In the environment materials like plastic and rubber are bad conductors but good insulators.
The movement of ions or electrons in a conductor in response to a voltage force is termed _____________, and is measured in amperes (amp or A). Most therapeutic applications use _______, or ______.
Explain why PC (pulsed current) is used for muscle stimulation instead of DC.
-muscle stimulation instead of DC because the electrophysiological effects of DC or AC are not well suited for most electrotherapeutic applications (DC elicits a single twitch), thus the creation of pulse current.
- Pulse current is a unidirectional or bidirectional flow of ions or electrons that ceases for a small period of time before the next electrical current. (similar to a muscle contraction)
YOU MIGHT ALSO LIKE...
Chapter 15 Musculoskeletal Injuries and Exercise
Chapter 16 - Using Therapeutic Exercise in Rehabil…
EXS 301: Ch 14-16
OTHER SETS BY THIS CREATOR
Exam 3: Memory Psych
Chapter 20/21: Social Behavior
Psych 280- Memory Exam #2 study guide
BIO PSYCH EXAM 3 Study Guide