Lecture 10

Question 1

Clinical presentation of a patient with a joint disorder

Answer 1

impaired mobility
impaired muscle performance
impaired balance
functional limitations

Question 2

Arthritis

Answer 2

inflammation in a joint

Question 3

Arthrosis

Answer 3

limitation of a joint w/o inflammation

Question 4

Characteristics of Osteoarthritis

Answer 4

Usually after the age of 40
develops slowly over many years
caused by trauma, genetics, disease, mechanical stress
asymmetrical

Question 5

Appearance of OA on radiographs

Answer 5

sclerosis
decreased joint space
osteophyte formation
bone cysts

Question 6

Varus OA

Answer 6

decreased medial joint space

Question 7

Valgus OA

Answer 7

decreased space laterally in joint

Question 8

Most common sites of OA

Answer 8

Cervical and lumbar spine
DIP, 1st CMC, shoulder
hip, knee, 1st MTP

Question 9

OA Joint symptoms

Answer 9

stiff joints after sleeping or immobility, pain with weight bearing, crepitus, decreased ROM

Question 10

OA Systemic Symptoms

Answer 10

none

Question 11

Early Stages of OA Interventions

Answer 11

correct body mechanics and movement patterns, focus on proection

Question 12

Late stages of OA interventions

Answer 12

assistive devices and splints

Question 13

General interventions of OA

Answer 13

resistance exercises, usually isometrics
stretching/joint mob
Balance
cardio (no impact or twisting)

Question 14

Characteristics of Rheumatoid Arthritis

Answer 14

chronic, progressive, autoimmune
onset is 16-50 years of age
sudden onset; episodes last months to years
unknown cause

starts as inflammation of synovial joint and then changes the structure of cartilage and bone

Question 15

Joint symptoms of RA

Answer 15

redness, warmth, swelling
nodules
stiffness in the morning, increased pain with activity

Question 16

Systemic symptoms of RA

Answer 16

general malaise, fatigue, loss of appetite, weight loss, fever
other symptoms within other systems like ocular, respiratory, etc

Question 17

Location of RA

Answer 17

MCP, PIP, wrists, cervical spine, MTP, talonavicular, ankle, hip, knee, shoulder

can be multiple, bilateral, symmetrical

Question 18

RA nodules

Answer 18

extra-articular manifestations of RA
25% frequency
extensor surfaces of tendons/joints causes irritation, nodule forms

also can form in subcutaneous tissues, pads of toes/heels, viscera

Question 19

Interventions for RA during Active inflammatory period

Answer 19

joint protection
energy conservation
exercise, functional training, gentle isometrics to prevent atrophy. Decrease time but increase frequency

NO stretching of joints

Question 20

Precautions of RA

Answer 20

steroid use, lead to osteoporosis
ligament laxity
respect fatigue
cardio exercise may be limited with fatigue

Question 21

Contraindication of RA

Answer 21

no stretching or mobilization of swollen joints when in a flare up phase

Question 22

RA interventions during subacute/chronic stages

Answer 22

joint protection and activity modification
flexibility and strength
cardiovascular endurance
adaptive equipment

Question 23

Risk factors for primary osteoporosis

Answer 23

Comes on its own

postmenopausal
caucasian or asian
family history
low body weight
no PA
diet low in vitamin D and calcium
smoking

Question 24

Risk factors for secondary osteoporosis

Answer 24

develops due to another problem

GI disease, Crone’s
hyperthyroidism
chronic renal failure
RA

Question 25

Prevention of Osteoporosis

Answer 25

diet rich in viramin D and calcium heavy weight bearing exercise no smoking, limited alcohol PA helps to remodel bones

Question 26

Interventions for Osteoporosis

Answer 26

Aerobic training, 5x or more a week, moderate Resistance, 2-3x week, focus on fatiguing Functional, balance training

Question 27

Precautions Osteoporosis

Answer 27

any exercise that produces flexion and rotation of spine balance exercises if balance is impaired STAYING SAFE NOT SEDENTARY

Question 28

Contraindications Osteoporosis

Answer 28

vertebral compression fracture history must avoid flexion and rotation of spine

Question 29

NEMEX Training program

Answer 29

for patients with hip or knee OA aims to improve senory and motor control, achieving functional stability improves pain, physical function and PA, increases quality of life

Question 30

GLA:D and NEMEX

Answer 30

60 min program warming up, circuit, cool down role models are more experienced pts. quality is emphasized

Question 31

Good alignment

Answer 31

knee over toe not knee medial to toe

Question 32

Circuit portions

Answer 32

core stability postural orientation lower extremity muscle strength functional exercises 1-2 exercises per area, performed 2-3 sets, 10-15 reps

Question 33

How to increase difficulty

Answer 33

Progression varying # of, direction, velocity of movements increasing load changing support surface

Question 34

Core stability Level 1

Answer 34

Pelvic lift w/flex knees, short lever arm. both legs loaded Sit-ups, flex knees, both legs on ball, arms at sides, short lever arm

Question 35

Core stability Level 2

Answer 35

Pelvic lift w/semi flexed knees, long lever arm, both legs loaded Sit-ups: flex knees, both legs on ball, arms over chest (medium lever arm)

Question 36

Core Stability Level 3

Answer 36

Pelvic-lift as level 2, alternate load Situps: flexed knees, both legs on ball, hands behind neck (long lever arm)

Question 37

Postural Orientation Level 1

Answer 37

Slide forward/backward: standing, one leg Slide sideways: standing, one leg

Question 38

Postural Orientation Level 2

Answer 38

Slide forwards/backwards: as level one, on uneven surface Slide sideways: same

Question 39

Postural Orientation Level 3

Answer 39

Forward lunge: standing, take large step forward and then return Sideways lunge: standing position, take a large step sideways and then return

Question 40

Lower extremity Level 1

Answer 40

Hip ab/adductors: standing on one leg, rubberband other leg. Pull in and out Knee ext/flexors: Sitting, rubber band around one foot. Pull forward/backwards

Question 41

Lower extremity Level 2

Answer 41

As level one, but with increased resistance in rubberband

Question 42

Lower extremity Level 3

Answer 42

Hip ab/adductors: Level 2 and uneven surface Knee ext/flexors: Increasing resistance

Question 43

Functional Exercises Level 1

Answer 43

Chair stands: load on both legs, slight hand support. start in seated. Stair climbingL step up and step down on low step, with or without hand support

Question 44

Functional Exercise Level 2

Answer 44

Chair stands: without hand support Stair: medium step, with or without hand support

Question 45

Functional Exercise Level 3

Answer 45

Chair: one foot in front of the other, with/without slight hand support Stair: high step board

Question 46

Cooling Down

Answer 46

walking forward and backwards mobility exercises in lower extremity stretching exercises for 10 min