Hydrodynamics and Aquatic therapy

Question 1

Properties that support aquatic therapy

Answer 1

buoyancy, hydrostatic pressure, viscosity, and surface tension have a direct effect on the body in an aquatic environment

Question 2

buoyancy

Answer 2

is the upward force that works opposite to gravity. Clinical significance is buoyancy provides the person with relative weightlessness and joint unloading, allowing performance of active motion with increase ease.

Question 3

what is hydrostatic pressure

Answer 3

is the pressure exerted on immersed objects. Pascal’s law states that the pressure exerted by fluid is equal on all surfaces. as the depth increases so does the pressure

Question 4

clinical significance of increased pressure

Answer 4

Assist VR, induces bradycardia and centralizes peripheral blood flow. The proportionality of depth and pressure allows you to perform exercise more easily when closer to surface

Question 5

what is viscosity

Answer 5

Friction occuring between molecules of liquid resulting in resistance to flow- resistance is proportional to velocity of movement. Shorter lever arm results in increased resistance, increases SA in water increases resistance

Question 6

physiological effects of exercise in water

Answer 6

increase blood supply, heat is evolved- temperature rises. there is an increased metabolism in the muscles resulting in a greater demand for oxygen and increased CO2 production. ROM is maintained or increased, and muscle power increases

Question 7

Therapeutic effects

Answer 7

relieve pain and muscle, gain relaxation, maintain or increase ROM, re-educate paralysed muscles, strengthen weak muscles- develop endurance and power, improve circulation, improve confidence, warmth of water block nociception by acting on thermal receptors and mechanoreceptors

Question 8

contraindications

Answer 8

cardiovascular disease, cardiopulmonary disease, diabetic, balance disorder, history of CVA/ epilepsy, incontinence, cold/influenza, fever, skin condition, contaginous disease, hepatitis, tracheotomy, UTI, open wounds, surgery,

Question 9

Different stages to working with amputee

Answer 9

pre-operative, amputation surgery, acute post surgical, pre-prosthetic, prosthetic prescription, prosthetic training, community integration, vocational rehab, follow uo

Question 10

stage of working with amputee- pre operative

Answer 10

Ax ROM and muscle power

Question 11

stage of working with amputee- acute post- op

Answer 11

wound care, discharge planning, post-op chest physio, transfer practice, specific exercise to improve strength and exercise tolerance, maintain ROM

Question 12

stage of working with amputee- pre prosthetic rehab

Answer 12

set patients goals, early walking aids can be used to help decide on patients suitability for prosthetic limb, exercise therapy to prepare the limb for a prosthesis

Question 13

stage of working with amputee- prosthetic training

Answer 13

education around donning and doffing prosthetic, skin integrity and weight bearing, gait rehab program

Question 14

Recommendations for early amputee rehab

Answer 14

Early walking aids as an assessment and treatment, physio is aware that level of amputation/ pre-existing medical conditions, impact of level of amputation

Question 15

what is phantom limb pain

Answer 15

pain that is localised in the region of the removed body pard. It is poorly understood clinical phenomenon. described as crushing, toe twisting, hot iron, burning, tingling, cramping, shocking, shooting P and N. 3 theories- peripheral, central and spinal theories

Question 16

Phantom sensation

Answer 16

is universal and doesn’t correlate with pain reports. Three types of phantom sensation- kinetic (movement), kinesthetic (size, shape, position), exterorecptive (touch pressure, temperature, itch, vibration)

Question 17

peripheral theories

Answer 17

remaining nerves in the stump grow to form neuromas, which generate impulses- these impulses are perceived as pain in the limb. One theory says taht cooling of the nerve endings increases the rate of firing of the nerve impulses, which are perceived by the patient as phantom limb pain

Question 18

central theories

Answer 18

Melzack proposed that the body is represented in the brain by a matrix of neurons. Sensory experiences create a unique neuromatrix, which is imprinted on the brain. When the limb is removed, the neuromatrix tries to reorganise, but the neurosignature remains due to the chronic pain experienced prior to the amputation. This causes phantom limb pain after amputation.

Question 19

spinal theories

Answer 19

when peripheral nerves are cut during amputation, there is a loss of sensory input from the area below the level of amputation. the reduction in neurochemicals alters the pain pathway in the dorsal horn

Question 20

PLP- central adaptation treatment options

Answer 20

mental imagery, graded motor imagery, anti-neuropathic medication, physical exercise, prosthetic use, acupuncture/TENS, self massage, education

Question 21

PLP- peripheral sensitisation adaptation treatment options

Answer 21

irritant management, education, prosthetic, ensure good alingment and fitting, scar management, self massage, TENs

Question 22

PLP- psychological and social factors

Answer 22

Education
Sleep hygiene
Acupuncture
Physical exercise
Relaxation techniques
CBT
Referral for formal mental health/social support

Question 23

PLP= MSK factors treatment options

Answer 23

joint ROM/muscular
Maintenance of control and function of the limb by working segmental stabilisers as well as global mobilisers.
Trigger points/myofascial release
Neural mobilisation

Question 24

Chronic pain

Answer 24

the patient finds themselves in a vicious cycle of pain, which not solely due to disease. a person who has pain on movement avoids pain. Natural reaction= rest, this leads to secondary stiffness and weakness, worsening the symptoms that the individual is trying to avoid. Other issues then arise, which may include financial hardship and strained relationships, side effects from medications and lack of sleep.

Question 25

Biopsychosocial model of pain

Answer 25

The approach holds that the experience of pain is determined by the interaction between biological, psychological and social factors.

Question 26

Treating pain- pain neuroscience education-

Answer 26

Teaches patients way to rethink their pain, increase pain thresholds during exercise, decrease fear related to movement and decreased brain activity in brain regions associated with pain.

Question 27

pain neuroscience education- central sensitisation

Answer 27

Chronic pain is seen as not being caused by dysfunctional tissues but brain plasticity leading to hyper-excitability of the CNS known as central sensitisation. It can be defined as increased responsiveness of nociceptors in the CNS to either normal or sub-threshold afferent input, resulting in- hypersensitivity to stimuli, responsiveness to non-noxious stimuli, increased pain response evoked by stimuli outside area of injury

Question 28

pain neuroscience education- delivery

Answer 28

Simple pictures, examples, booklets, metaphors, drawings, workbook with reading, neurophysiology

Question 29

pain neuroscience education- content of sessions

Answer 29

Neurophysiolgy of pain- nociceptive pathways- neurons- synapses- action potential- spinal inhibition and facilitation- peripheral sensitisation- central sensitisation- plasticity of the NS

Question 30

pain neuroscience education- Chronic pain management

Answer 30

Education, TENS, exercise, assistive devices, assistive devices, manual therapy,