phys agents test 4

Terms in this set (79)

aquatic PT concept
- physiological effect of human submersion

- unique ways to manipulate & utilize benefits of water to progress therapeutic exercises

- provide manual therapy
aquatic PT indications
- poor stability / core
- weakness and deconditioning
- pain
- limited ROM
- muscle spasm
- limited or non WB
- gait deviation
- abnormal tone
- joint replacement
- arthritis
- fibromyalgia
- limited functional ability
- muscle / connective tissue injuries
physical properties of water
- buoyancy
- hydrostatic pressure
- thermal effects
buoyancy
upward thrust of water

Archimedes principle: a body immersed in a liquid experiences upward force equal to the weight of the liquid displaced

- COG vs COB
- metacentric effect
- 97% displaced fully submerged
hydrostatic pressure
perpendicular pressure exerted by water on immersed objects

- increases as depth of water increases (near surface easier than near bottom)

- creates pressure gradient
- decreased peripheral resistance at extremities
increase in hydrostatic pressure causes
displace venous blood proximally >> increase in cardiac volume >> increase in SV and CO
increased distension on atrium causes a
vagal response: decrease SNS increases PNS = relaxation benefits
hydrostatic pressure renal considerations
caution: renal patients - NO dialysis

consider: diabetes (exercise acts like insulin)

water immersion can increase urine output, sodium excretion, potassium excretion
thermal effects
effects can be more systemic

if large surface area exposed to hydro modality:
- 4x greater specific heat than air
- 25 x greater thermal conductivity than air

caution: burn patients- difficulty with thermal regulation cardiac patients
thermal effects continued
conduction - when patient, body part or water are all still

convection - when patient, body part or water are moving

radiation - loss of heat from body when water / air is cooler than patient

evaporation - loss of heat by sweating and drying of water on skin exposed to air
physiological effects of human submersion.

warm water leads to
analgesic effect >> sensory overload >> gate theory
cohesion / viscosity
tendency of water molecules to adhere to each other
adhesion
tendency of water molecules to adhere to molecules of other substances
FD = PCV^2A / 2G
FD= drag force
P = fluid density
C = coefficient of drag
V = velocity of object
A = frontal area of object
G= gravitational constant
unique ways to manipulate & utilize benefits of water to progress exercises
buoyancy vs resistance
fascia and fascial adhesions
- develop in normal response to injury and skeletal overload

- following healing, fascial adhesions usually resolve with restored normal movement

- excessive calcification on protein collagen matrix (effects on tensigrety)

- cycle of adhesion development
facial adhesion cycle
inflammation: acute: formation of adhesions to stabilize injured site >> limited ROM, possible nerve impingement >> maladapted ROM / compensated movement patterns / biomechanical mal- alignment >> chronic: layers of adhesions form away from initially injured site
Ai Chi
- active aquatic therapy modeled after Tai Chi and yoga
- hands off manner
- chest deep in water, rhythmic combination and deep breathing
aquatic PNF
- active aquatic therapy modeled after PNF.
- hands on or hands off
- series of functional, spiral /diagonal, mass movement patterns
- active or assisted movements
bad ragaz ring
- active or passive from Knupfer and PNF
- rings or floats in water
- can be used for flexibility or relaxation passively
fluid moves (Feldenkrais)
- active or passive modeled after Feldenkras
- fluid movements hands on or off
- based on early developmental stages of infant
- functional integration
Halliwick
- hands on through games
- patient cradled in water and is destabilized to teach balance and posture control
- rotational control patterns
swim stroke
- active therapy
- intent to rehabitate
- client horizontal and instructed to modify and execute swim strokes
task type training
- made for patients with stroke
- emphasize functional skills in functional positions
watsu
- passive therapy modeled after zen shiatsu
- stabilize or move one segment of body, resulting in stretch of another due to drag effect.
hydrostatic pressure goals
- decrease edema
- improve lung capacity
- decrease inflammation improving function and decreasing pain
- decrease muscle soreness due to increase removal of toxic waste due to improved circulation
buoyancy goals
- assist ROM
- progress gait in reduced WB environment
- decrease pain / spasm for progression of WB activities and functional skills
- support/turbulence for resistance to trunk stabilization, balance, gait, transfer activities
- increased response time for equilibrium reactions to learn high gait level / balance tasks
- increase reaction time and decrease fear of falling
- decrease joint stress when performing activity
- distraction to create negative pressure in inter vertebral discs
- decrease risk of impingement and decrease compressive forces
other aquatic therapy goals
- warm water and aquatic techniques to decrease rigidity and increase ROM
- improve balance thru buoyancy and metacentric forces
- viscosity to improve proprioceptive feedback / body awareness
- decrease BP as result of changes in cardiovascular and renal system and increase parasympathetic nervous system
- improve muscle balance due to viscosity
- 60% increase in central blood volume for increase fitness and metabolic burn
- increase pain tolerance as result of change in catecholamines
STM
- consists of evaluation of soft tissue
- involves application of specifically directed techniques to help normalize soft tissue dysfunctions
STM contraindications
- nausea
- severe pain
- fever
- recent serious injury
- pathological skin problem
- open wounds
- pathological condition which can be spread through lymph or circulation
- area of active bleeding
- acute inflammatory condition
- cancer
STM warning signs
- change in quality of pain
- lumps and tissue changes
- rashes and changes in skin
- onset of edema
- mood alterations
- change in habits
- bleeding or bruising
- nausea, vomiting, diarrhea
STM precaution
- abnormal sensation
- low blood pressure
- osteoporosis
- psoriasis
physical affects (affects all systems)
movement of: lymph, venous blood, lung secretions, edema, intestinal contents, hematoma contents

mobilization of :
muscle fibers, muscle masses, tendons, tendon in sheaths, skin and subcutaneous tissue, scar tissue, adhesions
physiologic massage effects
- increase blood and lymph flow
- increase flow of nutrients
- removal of metabolic waste
- stimulation of healing process
- resolution of chronic edema and hematomas
- increase extensibility of connective tissue
- pain relief
- increased joint movement
- facilitation of muscle activity
- stimulation of autonomic functions
- stimulation of vesceral function s
- removal of lung secretions
- arousal
- promotional of local and general relaxation
psychological massage effects
- relaxation
- relief of anxiety and tension
- stimulation of physical activity
- pain relief
- general feeling of well being
- arousal
endangerment sites
- anterior triangle
- posterior triangle
- axilla
- medial/lateral epicondyle
- sternal notch
- umbilicus
- dorsal 12th rib
- sciatic notch
- inguinal triangle
- popliteal fossa
ethical issues of STM
- adequate explanation essential
- if you detect reluctance / reservations, do not proceed. Choose alternative intervention
- since massage involves exposure of body part and direct touching, high standard of ethical practice is essential
- if you examine the cases that are presented to the AZ state board, you will find this as the area of continual violations
personal appearance
- personal hygiene and cleanliness are essential
- remove all jewelry from fingers, hands, wrists
- hands must be cleaned and groomed
- nails short and rounded
- hands warm,dry, supple
hands with cuts, open sores, worts or skin lesions not appropriate
ideal table
- adjustable height
- equipped with face/nose hole
- made in 3 sections, of which the two end portions can be lifted
- adjustable forearm rests
- casters and a lift lock mechanism
body mechanics
- controlled relaxed movements of the hand require posture that provides trunk stability and free movement of the arms
- therapist must use proper body mechanics and move both the lower and upper extremities together
- position of the patient and table should facilitate proper body mechanics
- one of most effective stances is standing fall out (walk standing) position
patient positioning
- patient must be in comfortable position
- patient kept as warm as possible through treatment with any body parts that are not being treated covered
- supports or adjustable tables should be used to position patient for maximal comfort while providing therapist with easy access to treatment area
draping
- any part of the body that is not being massaged should be draped with blankets or sheeting to ensure patient modesty and warmth
lubricants
- powders (unscented baby powder)
- soap and hot water
- oils, creams, lotion (eucerin, lanolin, baby oil)
direction of force
- centripidal - towards the heart, venous and lymphatic flow
- centrifugal - away from heart, arterial flow
- anatomical directions (transverse to plane of muscle, in line with muscle fibers)
pressure
- ranges from light to very deep
- depends on: type of stroke, purpose of stroke, pt problem

- pressure increases during the stroke, maximizing at the end
deep pressure produces
strong simulation - may increase tension and pain
light pressure produces
mild stimulation - may induce relaxation and decrease pain
rate and rhythm of strokes
- rate depends upon function of stroke
- general guidelines: 15 strokes per minute, 7 inches per second

slow strokes = relax
rapid strokes = stimulating
duration / frequency
- mobilization of chronic swelling around ankle = 10-15 minutes

- massage performed until desired effects are observed
- size and age of pt affect duration of treatment (smaller less time than larger)
- massage can be given daily or more
effleurage, stroking, skin rolling
stimulation of superficial blood and lymph flow

mobilization of skin and subcutaneous tissue

promotion of local and general relaxation

relief of pain
kneading, wringing, picking up
mobilization fo muscle tissue

stimulation of deeper circulation

promotion of relaxation

relief of pain
hacking, beating, pounding, clapping
stimulation of muscle activity and deep circulation
clapping, vibration, shaking
mobilization and removal of lung secretion
deep friction
mobilization and pain relief in tendons, muscles, ligaments, joint capsules
effleurage
General:
- superficial to deep in direction of venous flow
- assist venous and lymphatic flow

purpose:
- move contents of superficial veins and lymph vessels

technique:
- centripetal direction
- use palmar surface of one or both hands
(may use fingers or thumb for smaller areas)
- hands should be relaxed and molded to the body part
- stroke should be smooth and rhythmic
- distal to proximal

rate:
6-7 inches per second

depth/pressure:
- use significant pressure that gradually increases during each stretch

effects:
- stimulation of superficial blood flow
- promotion of local and general relaxation
- relief of pain
- mobilization of skin and subcutaneous tissue

variations:
- knuckling
- bilateral tree
- 3 count trapezius
- horizontal strokes
petrissage
general: several different massage strokes that are characterized by firm pressure applied to tissue with goal of deep tissue and skin / subcutaneous tissue

purpose:
- kneading, picking up, wringing to mobilize muscle fibers and deep tissue
- skin rolling to mobilize skin and subcutaneous structures

rate: slow and continuous around 4-6 inches / second

depth: kneading, pick up, wringing require significant pressure

effects:
- mobilization of muscle tissue
- stimulation of deeper circulation
- relaxation
- pain relief
- mobilization of skin and subcutaneous tissue (skin rolling only)
petrissage kneading
- pressure applied in circular motions with surface of hand and pads/tips of fingers / thumbs
- pressure increased during 1st half of circle decreased during 2nd half

- each circle takes 3-4 seconds
- significant pressure

mobilize muscle fibers and deep tissue
petrissage picking up
- tissue is grasped with whole hand, usually abducted
- initial pressure is upward then tissue is grasped and lifted away from the underlying structures, squeezed, and released

- significant pressure

mobilize muscle fibers and deep tissue
petrissage wringing
- tissues are grasped and lifted as in picking up, however 2 hands are used alternately in the line of the axis of the muscle

- significant pressure

mobilize muscle fibers and deep tissue
petrissage skin rolling
- with the hands side by side, thumbs abducted and touching, the skin and subcutaneous tissues are gathered in the palms then rolled by the thumbs

- not require significant pressure

mobilization of skin and subcutaneous tissue
tapotment
general: percussion manipulations with goal of stimulating tissues, either by direct mechanical means or reflex action

4 types: clapping/cupping, beating, hacking, pounding

purpose: tissue stimulation, loosen secretions when performed over lungs

rate: performed quite rapidly

depth/pressure
- clapping/hacking: lightly
- beating/pounding: deeper than clapping or hacking

effects: stimulation of muscle activity, stimulation of deep circulation, mobilization of lung secretions
tapotment techniques clapping/cupping
- palmar surfaces of hands are cupped
- palmer surface brought into contact with tissue by rapid alternating flexion / ext of wrists
tapotment techniques beating
- hand closed into loosely packed fist and dorsal surfaces of middle and distal phalanges are brought into contact with tissue
- can be unilateral or bilateral usually alternating
tapotment technique hacking
- single or double handed stroke lateral edges and dorsal surfaces of hand/fingers are brought into contact with tissue
tapotment technique pounding
- combination between beating and hacking, in which lateral borders of loosely clenched fist are brought into contact with tissue
friction massage
general: affect connective tissue of tendons, ligaments, muscle

classified as: deep, transverse, circular

purpose: mobilize adhesions in tendons, ligaments, joint capsules, muscle tissue

technique: applied without lubricant, transverse are performed at right angles to structure involved, circular are performed in circular movements over involved structures

rate: slow and steady

depth/pressure: very deep, significant pressure is applied to small area of tissue

effects: mobilization and pain relief of connective tissue adhesions
vibration / shaking
- single or double handed techniques designed to assist with removal of secretions from lungs
the most common factor that precipitates soft tissue pain and functional impairment is
trauma
trauma
from external force or repetitive internal / external microtraumas can produce long standing soft tissue changes
dysfunctional physiologic factors
- scar tissue adhesions
- lymphatic stasis & interstitial swelling
- thixotrophy (Shearing property)
- intermolecular cross linking
skin can lose normal mobility secondary to
trauma, scar tissue formation, immobility
skeletal muscle
connective tissue structures are continuous with each other and are interconnected with all other structures of the body
dysfunctions of the myofascial unit
- restrictive scar tissue
- restricted muscle play
- weakness through impaired peripheral and central innervation
- restricted extensibility & play of conn tissue elements
- adaptive muscle shortening
- injury of muscle/ tendon structures
- trigger points
- alternation in motor control / recruitment
global = massage example
effleurage from superficial to deep & back to superficial
local - specific technique example
effleurage to petrissage / skin rolling to friction massage & back to effleurage
acute strategies
- gentle oscillations
- relaxation
- decreased swelling via modalities & ice
- STM to associated soft tissue restriction
- STM in shortened range
- train in self care/ pain reducing exercise
subacute strategies
- improve soft tissue mobility
- more aggressive STM & more directed to injured tissues
- progress from shortened to lengthened range
- promote healing, initiate exercises and training in efficient posture / movement
chronic strategies
- STM to area and all associated areas, move toward lengthened range
- treat compensations
- aggressive rehabilitation and training in full return to work and activity
principles of intervention
- utilization of proper body position and body mechanics. Keep body in line of force
- ensure accurate evaluation, manual contact should be consistent & appropriate (soft/firm-superficial/deep)
- maintain contact with both hands to provide security for patient and to receive needed evaluation of effectiveness of techniques
- while palpating & treating, all finger joints should be held in a neutral to slightly flexed position avoiding end ranges that can be detrimental to joint structures
- take care of your hands
- if you are not relaxed patient will not relax
- breathing is important for therapist and patient for relaxation
- patients may be sore after sessions
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