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SA Phys Rehab > Exam 1 > Flashcards

Exam 1 Flashcards

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1
Q

What are the differences between NMES and TENS

A

NMES is for Muscle Weakness targeting MOSTLY Type I (slow twitch cardio) muscles fibers after initial Type II (fast twitch strength) fibers to create tetanic contractions of selected muscle groups WITHOUT PAIN

TENS is for Pain relief and uses hyper stimulation of nociception (pain gate theory) to release enkephalins (sensory level) and/or endorphins (motor level)

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2
Q

How can Non-noxious stimulation reduce pain?

A

Activates “closed” gate control mechanisms to reduce pain

Ex: soothing, rubbing, ice/heat, TENS

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3
Q

What are the indications for RICE?

A

Acute inflammatory response day 1 to 5

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4
Q

What are the indications for TENS?

A

Pain relief; acute/chronic pain

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5
Q

What are the indications for NMES?

A

Treat muscular weakness, disuse atrophy, early post-op edema

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6
Q

What are indications for ESWT?

A

Great for horses; OA, tendon/ligament injuries, nonunion or delayed healing fractures

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7
Q

What are indications for Therapeutic US?

A

Breakdown of scar tissue, increase elasticity of muscles, aid in healing, increase circulation, reduction of pain/spasms

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8
Q

What are indications for PEMF?

A

Wound healing, pain management, inflammation, post surgical healing, OA

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9
Q

What are the SENSORY settings for TENS?

A

Pulse duration: 2-50 pulses/usec
Frequency: 50-150 Hz (pulse/sec)
Duration: 20-30 min, no cycle time
Amplitude: comfortable tingling for the patient
GOAL: Produce enkephalin release

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10
Q

What are the MOTOR settings for TENS?

A

Pulse Duration: >150 pulses/usec
Frequency: 2-4 Hz (pulses/sec)
Duration: 30-45 minutes, no cycle time
Amplitude: visible muscle contraction
Goal: Endorphin release (long half life)

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11
Q

What are the settings for NMES?

A

Waveform: symmetrical or biphasic
Pulse duration: 100-300 usec
Frequency: 30-50 Hz (pulse/sec)
On/off time; strengthening: 1:3-1:5, Endurance: 1:1-1:2
Electrode size: larger more comfortable but appropriate for muscle groups you are trying to isolate
Treatment time: 15-20 min
Goal: tetanic contractions of selected muscle group WITHOUT PAIN

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12
Q

What are the settings for Therapeutic U/S?

A

Frequency:
1 MHz: longer wavelength penetrate 2-5 cm requires higher intensities
3.3 MHz wavelength penetrates 0.5-2cm requires lower intensities
Pulsed vs. continuous waves

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13
Q

What are contraindications for ESWT?

A

Infectious arthritis
Immune mediated joint disease
Immature bone
Cancer
Unstable fractures
Neurological deficits
Neural tissue
Lung tissue

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14
Q

What are contraindications for Therapeutic U/S?

A

Neoplasia
Areas of hemorrhage
Immediate injury
Eyes
Gonads
Gravid uterus
Ischemic tissue/devitalized tissue
Spinal cord post laminectomy
Phase two incision sites (wait at least 14 days)

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15
Q

What are contraindications for PEMF?

A

Tumors
Pregnant uterus
Open growth plates
Over the heart
Electro medical devices
Acute/active inflammation
Eyes

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16
Q

What are the healing qualities of PEMF?

A

Electrical currents—>increase Ca2+ concentrations—>creates short burst of NO prodxn—>vasodilation, osteoblasts proliferation, immune response, down regulation of Cox2, cellular proliferation, chondrocyte proliferation, reduction of cytokines

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17
Q

What are the healing qualites of therapeutic U/S?

A

Increase metabolic rate
Increase enzyme activity
Increase circulation
Increase extensibility in tissues
Decrease pain

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18
Q

What are the healing qualities of ESWT?

A

Reducing inflammation
Short-term analgesia
Increase neovascularization
Increase osteoblast activity
Realign fibers for more parallel healing

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19
Q

What are the healing qualities of NMES?

A

Selective contraction of a muscle group
Less strong than voluntary contraction
Recruitment of type II muscle fibers (strength fast twitch)
MOSTLY affects Type I muscle fibers (slow twitch cardio)

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20
Q

What are the healing qualities of TENS?

A

Stimulation of the A-Beta fibers via the TENS blocks smaller fiber activity.
Hyper stimulation of nociceptors (pain gate theory)

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21
Q

What are the settings for PEMF?

A

Acute/post op: every 2 hours self cycle option
Chronic: 2-3x/ week

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22
Q

Which manual therapies require specialized training?

A

Chiropractic work (joint mobilization)

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23
Q

What is massage?

A

The rubbing and kneading of muscles and joints of the body with the hands, especially to relive tension or pain; Tui Na in Vet med

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24
Q

What is effleurage?

A

Rhythmic stroking-mild/moderate pressure parallel with muscle fibers. Increase pressure with the larger areas, decrease with the smaller areas.

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25
What is petrissage/kneading?
Skin rolling, wringing or squeezing with moderate pressure. Benefits: breaks up adhesions/knots, relives muscle spasms, contractions, improved blood flow
26
What is tapotement?
Rhythmic percussion Benefits: stimulates skin and provides warmth, parasympathetic NS stimulation for longer periods of time
27
What is massage friction?
Soft tissue manipulation with thumbs and fingers perpendicular to fibers. Benefits: Great for joints and tendons, trigger points and to break up scar tissue
28
What is massage vibration?
Trembling movement with hands, fingers or massage gun Benefits relax before deeper massage, stimulates soft tissue, relives tensions, decrease stress
29
What is “normal end feel”?
When the joint has FULL ROM and the range is stopped by the anatomy of the joint
30
What is soft end feel?
Involving ST such as knee flexion (contact between ST of posterior leg and posterior thigh)
31
What is “Abnormal end feel”?
When the range of the joint is less or greater than normal. It is PAINFUL or when a structure other than the normal anatomy of the joint stops the motion
32
What are the grades of joint mobilization?
Grade I: small amplitude at the beginning of the ROM Grade II: Large amplitude not reaching the end of the ROM Grade III: Large amplitude reaching the limited ROM Grade IV: Small amplitude at the end of the limited ROM Grade V: Small amplitude and high velocity at the end of limited ROM (manipulation or thrust)
33
What is physiologic mobilization?
Motion that mimics voluntary movements
34
What is accessory mobilization?
Motion that could NOT be accomplished by voluntary movement
35
What are firm normal end feels?
Muscular stretch: ex hip flexion with the knee straight Capsular stretch: Ex: extension of the metacarpophalangeal joints of the fingers Ligamentous stretch: Ex: forearm supination
36
What are hard normal end feels?
Bone contacting bones: Ex: elbow extension
37
What are indications for joint mobilization?
Reduced joint range of motion
38
What are contraindications for joint mobilization?
Neoplasia Infection Malignancy Recent surgery Open wound Severe muscle contracture Instability
39
What are contraindications for massage therapy?
Cutaneous disease Shock Fever Acute incision Aggressive demeanor
40
What are indications for massage therapy?
Swelling and edema Prolonged recumbency OA Chronic pain Cancer pain Palliative/hospice Contractures Trigger points (MTPs) Athletic warm up and recovery
41
What are indications for PROM therapy?
Post surgical No active/voluntary limb use (plegic) OA
42
What are indications for stretching?
Athletes to prevent injury, conditioning Tightness: know the end feels, more difficult in chronic disease
43
Where do most acupuncture points lie over?
Type III: overlie superficial nerves or plexuses (70%), most points emerge from anatomical bony foramina
44
Which meridian is modulating the somatovisceral systems
Bladder meridian
45
What gauge needles is generally used in acupuncture?
28-34 gauge needles, there are coated and non-coated forms
46
What are adverse affects of acupuncture?
Bent or stick needles, broken needles, puncture of organs, puncture of joint capsules, infections, hematomas, EXACERBATION OF INITIAL CLINICAL SIGNS (things get worse before they get better. )
47
What acupuncture clinical application does not require any training?
Needling of trigger point complexes (Ashi/contraction knots)
48
What are the acupuncture points of the hip triangle?
BL54 (master point) GB29 GB30
49
What acupuncture point is the master point of the caudal back and hips?
BL40 (popliteal fossa in front of the popliteal LN)
50
What is the master acupuncture point of the stomach and GI?
ST36 (at the stifle) Stifle pain, GI motility issues or disease, pelvic limb dysfunction
51
What is the master acupuncture point for the chest and cranial abdomen?
PC6 (at the carpus)
52
What is PC6 used for?
Nausea, vomiting, cranial GI tract dysfunction, cardiac arrhythmias
53
What is ST36 used for
Stifle pain, GI motility issues or disease, pelvic limb dysfunction
54
What is BL40 used for?
Pelvic limb pain, weakness, urinary retention, stifle pain
55
What is the hip triangle used for?
OA and hipdysplasia
56
What is the master point of the face and mouth?
LI4 (ventromedial to the carpalmetacarpal joint)
57
What is LI4 used for?
Dental pain, facial pain, headache, sympathetic regulation, stomatitis
58
What is the Shen point/100 convergences?
GV20 (between the eyebrows at center of forehead), great for anxiety but doesn’t too much once the animal is at the veterinarian
59
What is GV20 used for?
Agitation, headaches, dizziness, CVA (stroke)
60
What is the resuscitation point?
GV26 (at the nasal filtrum)
61
What is GV26 used for?
Activation of sympathetic nervous system, aggressive use in resuscitation/CV arrest, apnea
62
What are the downstream effects of photobiomodulation?
Increase Angioneogenesis Increase neovascularization Increase collagen production Increase muscle regeneration Decrease muscle atrophy Decrease inflammation and edema Increase nerve regeneration Increase cartilage production Increase bone formation
63
What are the secondary mitochondrial downstream effects of photobiomodulation?
When the light is absorbed by Cytochrome C Oxidase biomodulation occurs with Increase ATP by 150% Modulation of ROS Increase release of NO Increase cytosolic Ca2+
64
What are the main applications of LLLT?
Reduce inflammation Promote tissue repair Induce analgesia
65
What are some indications for LLLT?
Inflammation Arthritis Trauma Ulcers/granulomas ST injuries Neuropathies Pain
66
What are the parameters of the type of light used in LLLT?
Monochromatic (one wavelength) Coherent (photons travel in same phase and direction) Collimated (minimal divergence over distance)
67
Is class III or Class IV laser for shallow treatments?
Class III (1-500 mW/ <0.5 W) is for shallow and probe must contact the skin directly Class IV (>500 mW >0.5W) is for deeper treatments and can be contact free as it has LONGER wavelengths
68
What are the tertiary effects of PBM?
Increase gene transcription Increase cell proliferation Cell migration Decrease Necrosis Decrease inflammation
69
What are quaternary effects of PBM?
Response to tertiary effect secretions Cells in blood and lymph will migrate to the Tx area to induce autocrine, paracrine and endocrine (bystanders) effects
70
How does LLLT produce analgesia?
Laser (>300 me/cm^2) absorbed by nociceptors which inhibit specific pain fibers, slow conduction velocity, reduce AP amplitude and suppress neurogenic inflammation
71
Why does PBM work on MTPs?
There is high electrical activity at these locations, LLLT reduces the amplitude of the APs to reduce pain
72
What is a concern of treating with Class IV lasers?
Increase risk of thermal injury when it comes to treating deeper structures (they have higher wattage)
73
What are contraindications for LLLT?
Over pregnant uterus Over open fontanel (space between bones for the skull of infant fetus where ossification has not completed) Over a tumor (retrograde signaling can make it more invasive) Over open growth plates of young animals Over thyroid gland NO PROBE CONTACT when treating open wounds
74
What power are fibroblasts stimulated with LLLT?
1-5 J/cm^2 which can increase collagen production, greater than 5 will inhibit and delay healing
75
Why is there a lot of research that says LLLT doesnt do what it advertises?
They don’t know how to design the study for long enough (or all the correct parameters) and they don’t know what the heck they are talking about
76
What is the weight distribution at a stance?
Normal; 60% FL and 40% HL
77
What is the weight distribution at a trot?
Normal: 120% FL and 75% HL (there is increased force)
78
What joint uses the most ROM at a walk?
Carpus; uses 50% of range, all other joints use very little. More speed will demand more ROM of all joints
79
Type I muscle fibers are (fast/slow) twitch for (anaerobic/aerobic) exercise and are used for (endurance/strength training). They also fatigue (slowly/fast)
Slow twitch Aerobic exercise Endurance Fatigue slowly
80
Type 2 muscle fibers are (fast/slow) twitch for (anaerobic/aerobic) exercise and are used for (endurance/strength training). They also fatigue (slowly/fast)
Fast twitch Anaerobic Strength training Fatigue fast
81
Which muscle fibers are recruited first when muscles are being used?
Type 2 fibers are recruited first then Type 1
82
What is the difference between isometric and isotonic muscle activity?
Isometric is where the muscles stay the same length Isotonic muscles change in length with concentric (shorten) or eccentric (lengthen) movements
83
Where is the majority of the movement in the spine?
Lumbar (7 vertebrae) within the T-L junction
84
What are the phases of healing in terms of length of time?
Phase 1: 1-5 days, acute inflammatory Phase 2: 5-21 days, subacute proliferative Phase 3: 21-60 days, consolidation phase Phase 4: 61+ days, Organizational phase
85
What are some of the excercise indications for musculoskeletal disorders?
OA (chronic disease assigned in Phase 3) Conservative therapy
86
What are contraindications to exercise?
Deterioration occurs with exercise Febrile Acute musculoskeletal injuries (fractures, torn ligaments, etc) Acute neurological compression Serious internal disease process Serious cardiac diseases Acute thrombosis, venous thrombosis
87
What are some examples of P1 ground exercises?
Standing ( P1) Weight shifting (P1-P4) Rhythmic stabilization Slow walking (P1 and P2 level surfaces) Cavaletti and weave poles Balance discs (P1-P4)
88
What are some examples of P3-P4 ground exercises?
Handshaking (P3-P4) Slow walking on uneven surfaces for dynamic weight stabilization (P3-P4) Creative use of balls Backwards walking Incline walking Decline walking Ascending/descending stairs Sit to stands Dancing Wheelbarrow Army crawls
89
What property of water allows for a decrease in overall weight on an animal?
Buoyancy
90
At what level does the water in UWTM need to be to get the weight of the animal to shift to the front?
The hip
91
What property of water allows for the reduction of edema in a patient?
Hydrostatic pressure (caution with respiratory patients)
92
What are contraindications of aquatic therapy?
Severe cardiac or respiratory disease Infections Biosecurity orange Severe Diarrhea Laryngeal paralysis Fecal incontinence Patients with UTI (be on ABx for 72 hours prior)
93
What water level does most flexion of the joint occur?
At or above the joint Hip has more fexlion at ANY water level Stifle has more flexion at DEEPER water
94
What are contraindications for swimming therapy?
Cervical instability Post op patients before P3 or P4
95
What is one thing canine athlete owners love to give?
Supplements! Make sure you get a full list/history on these
96
How is gonadectomy status important for history?
Fixing prior to puberty can predispose to orthopedic injury
97
What are two low impact canine sports that are uncommon to have injuries?
Rally Conformation
98
What is a common injury for obedience?
Left shoulder injuries because they are staring at their owners the whole time
99
What is are common injuries of flyball?
Chronic repeated stress injuries or the shoulder, carpus, iliopsoas, medial shoulder syndrome and hip arthritis
100
What are common injuries of dock diving?
Back pain Hips
101
What are common injuries of field trials/hunt trials?
Feet Carpus Shoulders Arthritis Carpal hyper extension
102
What are some considerations for FHO rehab?
Maintain ROM IMMEDIATLEY to prevent too much fibrosis Longer term NSAIDs and possible Gabapentin
103
What are complications of THR?
Luxation Infection Fracture Implant failure/loosening
104
What are important rehab considerations for THR?
3 months of EXTREME CARE to prevent hip dislocation No abduction/adduction Leg moves in saggital plane only OWNER EDUCATION: some surgeons don’t instruct owners to perform PROM at home
105
What is the timeline for THR limb function rehab?
Regain limb function: 2-10 weeks with limb placement (slow walks/gentle weight shifting) Limb strengthening: 10-12 weeks (check radiographs first)
106
The (medial/lateral) meniscus injury is more common
Medial meniscus (tibia and median collateral ligament)
107
What is the goal of the lateral fabellar suture procedure?
Prevent cranial displacement of the tibia, scar tissue forms over joint to stabilize long term
108
What modalities can be used with LFS in rehab?
TENS and massage to reduce edema PROM Day 1 and therapeutic U/S to improve ROM
109
What is the rehab schedule for LFS?
Day 1: PROM Week 2: avoid extreme flexion and extension; can do gentle passive stretching and start UWTM Week 4-5: no stair climbing until week 5 to 6; can do cavaletti poles to add more AROM
110
When can you add UWTM to TPLO and TTA post op?
As early as 2 weeks
111
What are complications of TPLO and TTA?
Meniscus tear CCL rupture on other limb Fracture, infection, implant loosening Patellar desmitis
112
What are rehab considerations for TPLO and TTA?
Avoid TENS and Laser over the plate Avoid extreme flexion/extension until week 6 Avoid increased loading exercises until week 8-10 Don’t walk more than 20 min 2x/day until recheck of radiographs
113
What procedure fixes a patellar luxation?
TTT and trochlear wedge recession
114
What are TTT rehab considerations?
Improve ROM on SAGGITAL plane only Gradual increase of limb use but still avoid extreme flexion and extension
115
What is the difference between physcial therapy and physical rehab?
State practice acts limit the term, physical therapy is for human medicine. Physical rehab is what we use for animals term wise
116
What are post surgical neurologic indications for Physcial rehab?
Ventral slots Hemilamenectomies Stabilizations
117
Are there reasons to do physical rehab over surgery?
Yes Financial constraints Comorbidities PREHAB
118
Why should you meet a potential physical rehab patient outside?
Neutral environment and fear free. You can see how the patient interacts with the owner as well
119
What phase does suture removal occur in?
Phase 2 ( Day 5 to 21) subacute/proliferative
120
Which phase is the “stupid phase”?
Phase 2 (day 5-21) subacute/proliferative phase. Collagen is very fragile at this point (pre 14 days) risk of reinjury is high here. Owners get a little less strict because things look to be doing better…but things are still fragile
121
What phases are great for rechecks?
Phase 2 for suture removal (Day 5 to 21) subacute/proliferative Phase 4 (day 61+) organizational phase
122
Why is nutrition important in physical rehab?
Fatter patients have more difficulty because of excess weight
123
Why is the dog’s job important in the patient history?
Is it a couch potato or agility star. Helps to get realistic expectations of the rehab as well as the owner’s commitment to the tasks
124
What are three areas that are important to check on PE of Physical Rehab evaluation
Iliopsoas (compensatory problems) Thoracolumbar+sacroiliac Caudal to scapula (weight bearing)
125
How do you approach pain with a physical rehab treatment plan?
Presence of pain Acute Pain: modalities and manual therapies Chronic Pain: modalities, manual therapies and exercise Absence of pain: just exercise
126
What is the normal ROM for the STIFLE joint?
Normal FLEXION of stifle: 40-43 degrees Normal EXTENSION of stifle: 160-164 degrees
127
What is the normal ROM for the coxofemoral joint?
Normal FLEXION of coxofemoral joint: 48-52 degrees Normal EXTENSION of coxofemoral joint: 160-164 degrees
128
What is gradual increase of amplitude over time and how does it relate other the patient?
Ramp: relates to patient comfort
129
What tissue temperature should TUS be maintained at and for how long?
104-112 F for no longer than 5 minutes
130
Which modality house you let patents react to?
Therapeutic US; dont sedate too much, dont ice

SA Phys Rehab (1 decks)

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