Arthritis

Question 1

goals of exercise intervention

Answer 1

slow or reverse body’s response to joint pathology by increasing strength, flexibility, endurance and by decreasing pain

improve impairments, functional limitations, and disabilities resulting from arthritis

lead to overall improved health status as an effect of cardiovascular, strengthening, ROM and stretching exercises

Question 2

ligs, muscles, tendons, capsule, cartilage, bone

Answer 2

stabilize
absorb
transmit forces

Question 3

OA

Answer 3

nonsystemic
mostly noninflammatory
localized pathology

Question 4

RA

Answer 4

systemic
inflammatory disease
usually involves multiple joints
often affects organ systems

Question 5

articular cartilage function

Answer 5

shock absorption

joint congruence

Question 6

effects of OA on articular cartilage

Answer 6

thickening to softening

thinning to loss

Question 7

effects of RA on articular cartilage

Answer 7

erosion

Question 8

synovium function

Answer 8

secretes synovial fluid for nutrition of cartilage, lubrication and stability

Question 9

effects of OA on synovium

Answer 9

abnormal joint alignment stresses

Question 10

effects of RA on synovium

Answer 10

microvascular lining cells activated by inflammatory process
pannus formation (granulation tissue)

Question 11

ligament function

Answer 11

stability
reinforce capsule
limit movement
guide movement

Question 12

effects of OA on ligaments

Answer 12

abnormal joint alignment stresses

Question 13

effects of RA on ligaments

Answer 13

erosion

weakens

Question 14

muscle function

Answer 14

reinforce joint capsule
reflex joint protection
move joints

Question 15

effects of OA on muscle

Answer 15

immobility shortens pain, causes guarding and reflex inhibition leading to weakness

Question 16

effects of RA on muscle

Answer 16

joint deformity interferes w/ peak torque
immobility shortens
myositis weakens
pain & effusion cause guarding
reflex inhibition leads to weakness

Question 17

bone function

Answer 17

structural support

Question 18

effects of OA on bone

Answer 18

subchondral bone remodeling changes shock absorption properties

joint margin spurring leads to bony blockage and pain

Question 19

effects of RA on bone

Answer 19

erosion leads to joint deformity
bony blockage
pain

Question 20

OA effects on extra-articular system function

Answer 20

increased energy expenditure from abnormal movement patterns

Question 21

RA effects on extra-articular system function

Answer 21

myositis
anemia
sleep disruption
fatigue
increased energy expenditure from abnormal movement patterns

Question 22

RA Class I

Answer 22

EARLY
completely able to perform usual ADLs

no destructive changes on roentgenographic exam

roentgenologic evidence of osteoporosis may be present

Question 23

RA Class II

Answer 23

MODERATE
able to perform usual self-care and vocational activities, but limited in avocational activities

roentgenologic evidence of osteoporosis, with or without slight subchondral bone destruction; slight cartilage destruction may be present

no joint deformities, although limitation of joint mobility may be present

adjacent muscle atrophy

extra articular soft tissue lesions, such as nodules and tenosynovitis

Question 24

RA Class III

Answer 24

SEVERE
able to perform usual self care activities, but limited in vocational and avocational activities

roentgenologic evidence of cartilage and bone destruction in addition to osteoporosis

joint deformity, such as sublux, ulnar deviation, or hyperextension, w/out fibrosis or bony ankylosis

extensive muscle atrophy

extra-articular soft tissue lesions, such as nodules and tenosynovitis, may be present

Question 25

RA Class IV

Answer 25

TERMINAL limited in ability to perform usual self-care, vocational and avocational activities fibrous or bony ankylosis criteria of stage III

Question 26

exercise recommendations and wellness

Answer 26

appropriate exercise regiment should emphasize: - maintaining appropriate BW - sustaining good postural alignment - developing good muscular strength and length - correct movements during functional activities

Question 27

therapeutic exercises for OA

Answer 27

- decrease pain and inflammation - re-establish muscle length and strength around the joint - address adaptive changes in proximal and distal joints - performance of basic functional tasks

Question 28

therapeutic exercises for RA

Answer 28

*considerations are similar to OA PLUS -pts must be taught how to recognize symptoms, to modify activity according to symptoms development and stage of illness

Question 29

results of pain

Answer 29

``` pain, swelling and splinting disuse atrophy reduce protective reflexes further cartilage breakdown disruption of soft tissue balance inefficient movement/muscle patterns decrease in cardiovascular activity activity reduced further ```

Question 30

pain

Answer 30

exercise is used to restore muscle balance, joint ROM, CV conditioning thermal modalities and estim for management

Question 31

impaired mobility and ROM can be diminished by:

Answer 31

- stiffening and shortening of muscles or tendons from spasm, guarding, or habitual postures - capsular stiffness or contracture - loss of joint congruity because of bony deformity

Question 32

RA prescription

Answer 32

1-2 daily application of PROM (large joints) and AROM (small joints) single submax isometric contractions (2/3 of MVC) 6 sec work/20 sec rest (acute and subacute phases) caution should be used during MVC efforts reps at various angles

Question 33

OA prescription

Answer 33

isometric contractions in acute phase as pain and swelling decreases, graduating into a routine containing dynamic contractions

Question 34

impaired aerobic capacity

Answer 34

CV training should be a major part of therapy programs with OA or class I and II of RA *aquatic therapy

Question 35

aquatic benefits

Answer 35

allos performance of movement patterns that may not be possible on land bc of balance or strength deficits provides ms relaxation modifying pain perception through sensory stimulation

Question 36

special considerations

Answer 36

protect joints during strengthening when lig or capsular laxity exists restore muscle balance when splinting, postural habit, pain inhibition has weakened muscle groups around 1 or more joints normalize specific joint movement patterns restore functional activities treat pain during and after exercise