Chapter 16 - Using Therapeutic Exercise in Rehabilitation

Question 1

RAMP

Answer 1

rehab goals
management of Acute responses
restoration of mobility
successful completion of performance goals

Question 2

effects of immobilization on muscle

Answer 2

atrophy and fiber type conversion (mostly type 1 - slow twitch)

prevent with e-stim and iso contraction

decreases neuromuscular efficiency (returns within 1 week)

Question 3

effects of immobilization on joints

Answer 3

loss of normal compression
decrease in lubrication
degneration

prevent: passive motion, e-stim, hinged casts

Question 4

effects of immobilization on ligaments and bone

Answer 4

weakening

preventing: high freq, short duration endurance exercise
may take 12 months of rehab

Question 5

effects of immobilization on cardiorespiratory system

Answer 5

resting heart rate increases .5 bpm for each day

stroke volume, max oxygen uptake, vital capacity decrease w/ increase in heart rate

Question 6

major components of rehabilitation program

Answer 6

minimizing initial swelling

controlling pain

restoring range of motion

restoring muscular strength, endurance, power

regaining postural stability and balance

maintaining cardiorespiratory fitness

incorporation function progressions

Question 7

minimizing swelling

Answer 7

RICE

reduce secondary cell death

Question 8

controlling pain

Answer 8

RICE, medications

Question 9

restoring range of motion

Answer 9

attributed to contracture of CT or resistance to stretch .

restore physiological and accessory movements

Question 10

restoring muscular strength, endurance, and power

Answer 10

isometric
PRE
Isokinetic exercise
testing strength, endurance, and power

Question 11

isometric

Answer 11

early rehab phase
increase static strength
decrease atrophy

Question 12

PRE

Answer 12

Progressive Resistance Exercise

free weights, machines, tubing , etc
isotonic contractions
concentric and eccentric contractions

Question 13

isokinetic exercise

Answer 13

later stages of rehab, fixed speed with accommodating resistance to provide maximal resistance throughout ROM

calculate torque, average power, total work, ratios of torque to body weight

Question 14

testing strength, endurance, and power

Answer 14

evaluations though manual muscle tests, resistance exercise, isokinetic dynamometers

Question 15

re-establishing neuromuscular control, propioception, kinesthesia, joint position sense

Answer 15

mind’s attempt to teach the body conscious control of a specific movement

• several reps, same movement, progression from simple to complex
• functional strengthening, re-learning sensory pattern, dynamic stability, preparatory and reactive muscle characteristics,

Question 16

propioception

Answer 16

ability to determine the position of a joint in space

mediated by mechanoreceptors (muscles and joints) and by cutaneous, visual, and vestibular input

Question 17

kinesthesia

Answer 17

ability to detect movement

Question 18

joint mechanoreceptors

Answer 18

in ligaments, capsules, menisci, labrum, and fat pads.

Question 19

muscle mechanoreceptors

Answer 19

muscle spindle (changes in length) and Golgi tendon organ (changes in tension)

Question 20

regaining postural stability and balance

Answer 20

integrating muscle, neuro, and biomechanical info

positioning the body’s center of gravity within the base of support

Question 21

Phases of injuries

Answer 21

acute inflammatory response stage (1-4 days)

fibroblastic repair phase

Maturation-remodelign phase

Question 22

rehab during acute phase

Answer 22

control swelling and

modulate pain

RICE

rest for only the injured body part

day 3-4: active mobility exercise, pain free ROM, progressively bear more weight

NSAIDS

Question 23

rehab during fibroblastic repair phase

Answer 23

maintain cardio, restore full ROM, increase strength, re-establish neuromuscular control

modalities to control pain and swelling (cryotherapy, e-stim)

Question 24

rehab during maturation phase

Answer 24

goal: RTP
fibers realign according to tensile stress placed upon them

aggressive AROM and strengthening

sport specific activities

dynamic functionality

plyometric strengthening

thermal modalities

Question 25

CKC

Answer 25

closed kinetic chain forces begin at ground forces absorbed by various structures offer more functionality

Question 26

contract-relax

Answer 26

move part passively until resistance is felt; athlete contracts antagonistic muscle isotonically (movement resisted by AT for 10 seconds or until fatigue); athlete relaxes for 10 seconds; limb is passively moved to a new stretch position (repeat process 3 times)

Question 27

hold-relax

Answer 27

move part passively until resistance is felt; athlete contracts antagonistic muscle isometrically (movement resisted by AT for 10 seconds or until fatigue); athlete relaxes for 10 seconds; limb is either actively or passively moved to a new stretch position (repeat process 3 times)

Question 28

slow-reversal-hold-relax

Answer 28

athlete actively moves body part to point of resistance and holds position; muscles are isometrically resisted by AT for 10 seconds. Athlete relaxes for 10 seconds, thus relaxing the antagonist while the agonist is contracted, moving the part to a new limited range

Question 29

repeated contraction

Answer 29

used for general weakness or weakness at one specific point. Athlete moves limb isotonically against manual resistance until fatigue (at time of fatigue, stretch is applied at that ROM to facilitate greater force production)

Question 30

slow-reversal

Answer 30

athlete moves thru complete ROM against maximal resistance (examiner reverses resistance as movement pattern reverses) = promotes normal reciprocal coordination of agonist/antagonist muscle groups

Question 31

rhythmic initiation

Answer 31

progressive series of passive movement 􏰀 active assistive movement 􏰀 active movement through an agonist pattern (helps athletes with limited ROM regain strength)

Question 32

rhythmic stabilization

Answer 32

uses an isometric contraction of the agonist, followed by an isometric contraction of the antagonist muscles

Question 33

PNF flexibility techniques

Answer 33

contract-relax hold-relax slow-reversal-hold-relax

Question 34

PNF strength techniques

Answer 34

repeated contraction slow reversal rhythmic initiation rhythmic stabilization

Question 35

repeated contraction

Answer 35

used for general weakness at one specific point move limb against resistance isotonically against manual resistance until fatigue then apply stretch at time of fatigue

Question 36

slow-reversal

Answer 36

athlete moves thru complete ROM against max resistance (reverse resistance as movement at pattern reverses) promotes normal reciprocal condition of agonist/antagonist

Question 37

rhythmic initiation

Answer 37

progressive series of passive movement --> active assistive movement--> active movement through an agonist pattern helps with limited ROM and to regain strength

Question 38

Rhythmic stabilization

Answer 38

uses an isometric contraction of the agonists, followed by an isometric contraction of the antagonist muscles