Intro - Stretching Flashcards
Physical therapy affects the following systems
Cardiopulmonary
Integumentary
Neuromuscular
Muscleskeletal
Common impair mg’d w/ Therex (Go by syst)
MSK: (P), weakness, hpyermobility, posture, length/strength imbalance, v|: torque pdn, endurance, ROM, periarticular CT, muscle length
NM: (P), impared bal/post ctrl, incoordin/timing, delayed moto dev, abn tone (hypo, hyper, dyst), ineffect func mvmt
CV/Pulm: v| aerobic capacity (CP end), circ (lmp, ven/art), (P) w/ sustained activ
Integume (hypomobil - e.g. immobil/adherent scar)
Composite impairment: defn + ex
Result of mult underly, combo of 1st or 2nd impair. E.g. severe inv sprain, talofib lig tear - immobil. Balance imparitment due to chronic lig lax (structural), impared ankle proprio from injur or weakness (functional)
Primary vs secondary impairment
Primary -> direct result of area of complaint
2ndary -> due to pre-existing condition (e.g. preexist postural impair)
Risk factor categories for disability
Bio, (e.g. height/weight, congential, gene pred)
Behavioral/psycho/lifestyle (cul. bias)
Physical environment (archit barr)
Socioeconomic (lim support)
Req for Clinic Decision Making during Pt mgmt
Relevant data via strateg examination
Cogni+ psychomotor (palp) to get data of unfamiliar issue
Efficient info-gath/process style (intake fm)
Prior exp w/ similar prob
Recall, integrate new and prior knowhow, Obtain quality evid from lit,
Critically synth info,
Form working hypothesis abt prob + soln
Pt value+ goal
Option analysis
Reflect+ self-monitor for adj
Evidence-based practice steps:
Pt Mgmt 5 basic components
1) Pt problem -> Question
2) Collect scientific, clinical evidence re: Q
3) Critically analyze abt quality in applicability of evidence to Q
4) Integrate evidence review w/ expertise + pt circumstances for decisions
5) Findings -> pt mgmt
5) Assess intervention outcome + adj
1) Examination
2) Evaluation
3) Diagnosis - impairments (activity + participation)
4) Prognosis + tx plan
5) Intervention
Pt Mgmt Step 1: Examination 3 distinct component
Pt health history (interview, other HCP report)
Systems relevant: CP, MSK, NM, Intg, GI/GU (genitouri), Cog+social/emo, gen/misc (unexplained weight loss, persistent fatigue)
Specific tests+measure: multiple lvl of function, data specific to support or reject hypo, help type fo int.
Pt Mgmt Step 2: Eval components
Gen health (pre-existing/comorbidities - DM) -> current/pot function
Acuity/severity of conditions
Extent of struct/func impairment -> funct abil (stability or progression)
Which impairmt-> limitations
Current/overall lvl of physical func:desired/needed func abilities
Impact of phy dys -> social/emo func
Impact of phys envi+ social support-> current, desired function
Pt Mgmt Step 3: Diagnosis defn for PT
PT classify dysfunction (mvmt or conseq of dys), Dr identifies disease
PT diag Class for MSK sysm patterns:
Primary prev/risk v| for skel demin (4A) Impaired post (4B) Imp'd muscle per (4C) Imp'd jt mobil, motr func, muscl perf, ROM due to: -C.T dys (4D) -Localized inflam (4E) -Spinal dys (4F) -fracture (4G) -joint arthroplasty (4H) -bony/soft tis surgery (4I) -amputation (4J), also re: gait, locomotion _ balance
Pt Mgmt Step 4: Prognosis + Tx Plan depends on:
1) Complexity + expected course of pathology, impairmt
2) Pt gen health, comorbidities
3) Prev lvl of function
4) Living environ
5) pt goal
6) Adher_ motiv, resp to prev intv
7) safety concerns
8) Ext of supp (phys, emo, soc)
Pt Mgmt Step 5: Q’s
Of problems, which do you want to try to elim or minimize?
What would make you feel you were making progress in achieving your goals?
How soon do you want to reach them?
PT’s Outcomes assessed:
Lvl of physical funct, and perceived disability
Extent of reduced risk of reoccurence
General health status
Degree of pt satisf
Stages of motor learning (3)
Cognitive (learn how + think each step), Associative (some errors), Auto
Taxonomy of motor task - Factors
Body Stable vs Body Transport (sitting/standing vs rolling, carrying to sw)
Closed (sitting on chair or stand on wood) vs Open (moving bus)
W/o Intertrial var vs w/ intertrial (diff height, )
3 types of prevention activities
Primary (preventing problem)
2ndary: decreasing Dx + sev of disease
3th Decrease degree of disability
Activity pre-screen Qs
“Ever diag’d w/ heart condition
Only physical activity under direction of Dr?
Any chest pain doing phys act
Diag w/ arth or osteoporo, ^| (P) when phys active?
Any Rx for BP or heart?
Ever lose blanace or consciousness?
Any condition prohibits you from doing Phys act?
Macrotrauma
Microtrauma
Acute, immedi (P) - frac, sublux, cont
Overuse, repetitive overload/biomx: itis - tendinosis
Inflammation Phase
Leukocyte, phagocytic -> injury by-products (2-7days), vasocon via CVS(10min)-hypoxia (angiogensis) -inflam-vasodil (macro/neu-remv deb), plat clot
Proliferation Phase
Epithel(w/i hr), granul tiss (stop gap 1st hrs until collagen syn) post-injury days-> 6 weeks
Remodeling
Macrophg break type 3 to 1, collagen 4-5 wks to str tiss, later align to stress (PROM), LT from 2weeks post
Framework Therex re: Tissue rehabilitation (5)
Healing (Inflam, Prolif, Remodel - G: ctrl inflammation AROM/RROM low int, short dur)
Mobility G: remodel along lines of stress-Stretch (SHARP gone/v| or 0 chg for >24hr)
Performance init ctrl - Resist, (Full mobil not reqd’ but (P)-free, daily Rx, aerobic) stabilize
Perf improv- Resist. G: Muscle ctract
Adv skill (near norm muscle perf) coord - Agility, Balance. G: incr complexity of functional task
Progression of Exercises - variable factors (2)
FIDS or stimulus/environment
