PT 2 Midterm Flashcards
(306 cards)
1
Q
Rehabilitation
A
early activation and returning to functional activities as soon as possible, sometimes in spite of pain, while de‐emphasizing the importance of tissue healing, pain reduction and pathoanatomical findings
2
Q
Bio‐Psycho social model
A
views pain as more than just the result of tissue injury. Psychological and social dimensions that are an intimate part of the problem and must also be addressed.
3
Q
Physical Deconditioning Causes:
A
fear avoidance behavior, pain inhibition, specific injury, disuse
4
Q
Physical Deconditioning Results:
A
joint immobilization, muscular disuse, diminished cardiovascular fitness; deficits of afferent system (proprioception, balance and coordination), central motor control of movement and posture; decline of skills in daily activities
5
Q
Identification of deconditioning syndrome:
A
immobility, muscles weakness, pain‐avoidance behavior
6
Q
What are the treatments for Phys Deconditioning?
A
local tissue immobilization is advised during the inflammatory phase (2‐3 days); during repair phase active and passive motion has positive effect on injured tissue
7
Q
Psychological Deconditioning Pain Perception:
A
pain does not simply result from structural injury or pathology, but is an unpleasant sensory and emotional experience associated with actual or potential tissue damage ; evaluation of the source of pain and the psychological perceptions that lead to activity‐limiting fears should be addressed so that reactivation can occur
8
Q
What is the value of high tech testing of Phys Deconditioning?
A
high tech testing: expensive, high false positive rates, pt is told nothing is wrong and labeled “psychogenic
9
Q
What is the correlation b/t clinical diagnostic labels and actual pathoanatomy?
A
diagnostic labels: correlation bt pathoanatomy and clinical symptoms is poor, labeling patients as having herniated discs of degenerative arthritis can have negative effects on recovery
10
Q
Describe illness behavior:
A
illness behavior: the cognitive association of activity with pain or anticipation of pain has been shown to be more predictive of physical performance than purely nociceptive factors
11
Q
“sick role”=
A
=patient succumbs to thinking they are injured or damaged and limits activities
12
Q
“normal illness behavior”:
A
‐“normal illness behavior”: in acute phase protective mechanisms to immobilize an injured area are usually appropriate
13
Q
“abnormal illness behavior”:
A
if protective mechanisms become memorized as a “pain‐motor program” they can lead to a chronic state
14
Q
“let pain be your guide”:
A
“let pain be your guide”: patients who are advised this often decondition as a result of their pain
15
Q
“hurt equals harm belief”:
A
it is important to i.d. patients who are fearful and avoid encouraging them to take on a “sick” role. Learning that pain does not always warn of impending harm or damage can encourage patients to remain active, avoid disability and prevent transition from acute to chronic pain
16
Q
“hurt equals harm”:
A
-> catastrophizing of pain->fear of movement-> activity avoidance-> deconditioning-> debilitation-> re‐injury
17
Q
Three types of symptom magnification syndrome=
A
1) refugee‐delayed resolution results from trying to escape from an irresolvable conflict
2) game player‐delayed resolution results from opportunity for positive gain
3) identified patient‐ this patients role exclipses/contains all others
18
Q
Findings that establish chronic disorders:
A
‐duration>6wks ‐dramatization ‐diagnosis dilemma ‐drugs (inappropriate use) ‐dependence ‐depression ‐disuse (physical deconditioning) ‐dysfunction (social dysfunction)
19
Q
factors predicting a slow recovery include
A
‐fear avoidance behavior ‐duration of disability ‐heavy job demands ‐past history of frequent recurrences ‐sciatica
20
Q
Most low back pain patients recover within __ weeks.
A
Six weeks.. [LBP high recurrence rate 33‐66%; chronic pain 5‐15%]
21
Q
All symptoms remaining unchanged for 2‐3 wks should be evaluated for ___.
A
risk factors of pending chronicity
22
Q
Patients at risk for becoming chronic should have tx plans altered to ___.
A
de‐emphasize passive care and refocus on active care approaches
23
Q
Yellow flags of psychological deconditioning:
A
- abnormal illness behavior (altered/lower level activity from stress,
fear or anxiety) - affective (emotional, anger, self pity)
- anxiety (apprehensive uneasiness of mind)
- depression (hopelessness, sadness)
- cognitive (coping strategy “hurt equal harm”)
- fear avoidance (emotional awareness or anticipation of danger)
- locus of control from without
24
Q
Denominators of success for chronic patients:
A
- thorough physical and functional exam performed
- report of findings given
- de‐emphasize pathology, disease and injury
- emphasis on self‐care
- reduction of any unfounded fear or anxiety about pain
- crystal clear recommendations about activities, activity modification and gradual exercise
- avoidance of emphasis on “high tech” testing, pathology, disease, injury or bed rest prescription
25
Steps to reduce LBP chronicity:
-dx oriented toward avoiding “labeling” the patient
-tx should reduce dependency on medication and other passive forms of tx (including manip) and encourage self‐treatment skills
rule out yellow flags
-control pain decrease pain‐related anxiety improve internal locus of control improve function
-reducing activity intolerances i.e. sitting, standing, walking intolerances
-return to work begin exercise program give appropriate exercise to improve motor control
26
activity modification advice to prevent injury:
sitting, lifting, steps, crutches, canes
27
The traditional medical approach to tissue injury (flawed)=
when tissues have healed, pain should be gone and function restored; tissue healing should signify the end of medically necessary care
28
back pain and disability frequently persist beyond ___.
the period of tissue repair
29
Phase I of Tissue Repair =
acute inflammation (48‐72hrs)
30
Can you use modalities in Phase I care (acute inflammation)?
Yes, modalities may help prevent swelling relieve pain and promote healing in this phase; support and rest are in order or gentle movement within the pain‐free range‐of motion
31
Phase II of Tissue Repair=
repair and regeneration (43hrs‐6wks)
32
During Phase II repair and regeneration (43hrs‐6wks), is it appropriate to introduce exercises?
Yes, rehabilitative exercises may be started and modalities may be applied but care must be taken so as not to overwhelm the damaged tissues
33
Phase III of Tissue Repair=
remodeling and rehabilitation (3wks‐12+mos):
34
Phase III aka remodeling and rehabilitation (3wks‐12+mos)=
aggressive exercises and restoration of normal neurological balance may be pursued to help re‐shape the repaired tissues and improve their strength, flexibility, endurance and ability to perform
35
Passive Care: (pain‐palliative) (acute)=
symptomatic relief and improves activity tolerance; passive care modalities usually fail to rehabilitate abnormal substitution patterns the patient either transitions to chronic pain or has recurrence of acute pain in near future
36
What are some palliative techniques?
manipulation, electrical stimulation, US, massage, traction, cold/hot, soft tissue therapies, herbs, supplements, reduce activity intolerances, increase patient satisfaction
37
Describe the transition to active care..
after 6 wks likelihood of recovery drops dramatically, physical deconditioning becomes responsible for continued pain, psychological deconditioning becomes responsible for continued pain
38
Active care: (rehabilitative model) occurs after _____ weeks.
appropriate for sub‐acute or chronic cases; exercise has been proven to be more effective than passive care in chronic cases; patients should transition from passive care to active care after 6 wks
39
What are some examples of active care techniques?
PIR, proprioceptive neuromuscular facilitation and other manual resistance techniques for muscles balance and flexibility; spinal stabilization for motor control, speed of contraction, coordination and endurance; strength/endurance/speed of contraction; sensory motor training (propriosensory training, coordination, balance); postural advice (bruggers); soft tissue techniques
40
When can rehab exercises begin?
as soon as soft tissue inflammation has resolved injury and no later than 6 weeks after initial injury
41
How long does rehab generally take?
rehab may take 3 weeks to over 12 months for complete soft tissue remodeling and strengthening
42
What is a reasonable goal for injury healing?
rehabilitate the patient to within 10% of the strength and endurance levels of the normal (uninjured) area
43
Should a rehab treatment focus on pain resolution or cause of dysfunction?
treat any underlying pathology, evaluate dysfunction not pain or pathoanatomy and don’t over rely on “high‐tech” procedures
44
What is the prognosis for Acute phase (3‐4 wks)?
good prognosis for most patients; don’t medical‐ize the problem
45
Subacute phase (4‐12 wks)=
: aggressive between 3‐6wks to prevent chronic pain behaviors; avoid modalities; decrease fear‐avoidance behavior by gradually exposing to perceived painful activities
46
Muscle Dysfunction:
usually secondary to joint dysfunction; abnormal movement patterns if repeated long enough, muscle imbalances will become memorized in the cerebellum as a faulty motor program
47
Does adjusting correct faulty motor problems?
Nope. Adjusting: tx for joint dysfunction, but exercise corrects faulty motor patterns; adjustments are often short term; after adjusting exercise to restore muscles balance and motor programming is necessary to reduce recurrence
48
Aerobic exercise qualifies as _______ conditioning.
"general" conditioning
49
What kind of advice can you give your pt?
Work place modifications/ patient ed: posture, repetitive strain, and relaxation strategies optimize results
50
ABCCC’s of active care:
```
‐A=Adjust, mobilize
-B=Balance muscles
‐C=Control and coordination
‐C=Change ergonomic or behavior patterns
‐C=condition
```
51
functional reactivation=
level one active care to gradually resume normal activities; level two active care exercise to retrain “weak link”
52
What is the Bio‐pyscho‐social behavioral approach to active care?
“yellow flags” assessment if no progress, outcomes management
53
level two active care exercise=
retrain “weak link”
54
What are some examples of general advice to give to a Pt?
stay as active as possible, gradually increase, hurt does not equal harm, being too careful is worst form of self‐treatment
55
What's some other common sense from the note packet?
inform and discuss recovery goals and the means to reach them, teach patients to take an active role, reduce modifiable risk factors, and avoid impulsively seeking mainly symptomatic relief
56
What is the reassurance reactivation strategy?
reassurance of safety of gradually resuming normal activities such as walking, swimming and biking; these may be uncomfortable, but are less stressful than prolonged sitting
57
Reactivation strategies=
Pt education, pt advice, continue ADLs, information, reassurance, emphasize fitness, return to work, activity modification
58
Passive stretching:
external force applied while the patient is relaxed, either manually or mechanically, to lengthen shortened tissues
59
Active stretching:
the patient participates with voluntary contractions against resistance to inhibit tonus in a tight muscle during the stretching maneuver (manual resistive techniques MRTs)
60
Goals of stretching:
1. regain or reestablish normal range of motion of joints
2. prevent irreversible contracture
3. increase general flexibility prior to strengthening
4. prevent or minimize the risk of injuries related to physical acivites or sports
5. joint mobilization
61
Indications for stretching=
1. when range of motion is limited
2. when limitations might lead to structural deformities
3. when contracture interferes with everyday functional activities
4. when there is muscle weakness and opposing tissue tightness; tight muscles must be elongated before weak muscles can be effectively strengthened
62
Contraindications to stretching=
1. bony blocks that limit jt motion
2. recent fracture
3. acute inflammation or infection in and around jts
4. sharp acute pain with joint movement or muscle elongation
5. hematoma or tissue trauma
6. when contracture or shortened soft tissues provide increased joint stability or functional ability
7. spasticity or rigidity: UMNL
8. muscular diseases: dystrophy, myositis 9. when the patient is uncooperative or the doctor is stressed
63
Precautions for stretching=
1. do not passively force a jt beyond its normal range of motion
2. fractures must be stabilized before stretching an adjacent joint
3. extra caution with patients with known or suspected osteoporosis
4. avoid vigorous stretching of tissue that has been immobilized for a long period of time
5. joint pain or muscle soreness lasting more than 24 hours indications too much force
6. avoid stretching edematous tissue because it is more susceptible to injury than normal tissue
7. avoid over stretching weak muscles, particularly postural muscles
64
Manual passive stretching:
doctor applies external force and controls the speed, intensity and duration of the stretch. Tissues are elongated beyond their resting length; gains achieved with short‐duration manual passive stretching are transient compated to long‐duration mechanical stretching
65
Prolonged passive stretching:
low intensity external force (5‐15 lbs) is applied over a prolonged period of time
66
What is the purpose of active stretching?
stretch shortened muscles and their associated fascia, facilitate/train muscle that is weak/inhibited, and relax over‐active muscles
67
advantages of active stretching=
allows for more precise patient positioning, greater degree of control, proprioceptive stimulation, helps improve coordination, and is more comfortable than high‐intensity short duration passive stretching
68
disadvantages of active stretching
high‐intensity stretch affects primarily elastic structures and produces only temporary increases in muscle length
69
Reciprocal innervation (reciprocal inhibition)=
when one muscle is
| contracted, its antagonist is automatically inhibited
70
Post‐contraction inhibition (autogenic inhibition)=
after a muscle is contracted it is automatically in a relaxed state for a brief, latent period
71
Technique principles of stretching:
patient participates with a voluntary muscle contraction‐‐‐patient’s isometric or isotonic contraction inhibits muscle tone‐‐‐ resisted effort is followed by a short period of reflexive relaxation of the muscle and the muscle can be elongated or stretched
72
It is important to allow muscle to _____ before attempting any aggressive stretch.
relax
73
“release phenomenon” =
causes the muscle to lengthen automatically after relaxing
74
Active stretching is only possible if the muscle to be stretched is ______.
normally innervated and under voluntary control and cannot be used in patients with severe weakness, spasticity or neuromuscular dysfunction
75
contract‐relax‐antagonist contract (CRAC)=
uses both post‐contraction inhibition and reciprocal innervation
76
post‐isometric relaxation (PIR)=
primarily for trigger points and hypertonicity due to interneuron dysfunction; uses facilitation/inhibition of muscles that accompany breathing and eye movements
77
Who founded post‐facilitation stretch (PFS) and what is it used for?
Vladimir Janda; used specifically for muscle tightness, not appropriate for trigger points or hypertonicity
78
Why is post‐facilitation stretch (PFS) not appropriate for trigger points or hypertonicity?
due to interneuron or limbic system dysfunction is present in the absence of muscle tightness; requires maximum isometric contraction followed by complete relaxation and a quick vigorous stretch
79
How does eccentric muscle energy procedure (Eccentric MEP) (MET) compare to PFS?
osteopathic version, an alternative to PFS, and generally less intense
80
Proprioceptive Neuromuscular Facilitation=
the promotion or hastening of any natural process; the reverse of inhibition; specifically the effect produced in nerve tissue by the passage of an impulse; the resistance of the nerve is diminished so that a second application of the stimulus evokes the reaction more easily
81
In ______, the resistance of the nerve is diminished so that a second application of the stimulus evokes the reaction more easily
PNF
82
PNF is a method of promoting or hastening the response of the neuromuscular mechanism through _______.
stimulation of the proprioceptors
83
Normal motor behavior requires the use of many combinations of ______.
"motion" that have been learned over time and have become integrated into patterns of movement
84
Movement patterns that are spiral in nature and occur in what types of planes?
diagonal
85
In PNF, emphasis is placed on applying _____ throughout the range of motion.
maximal resistance
86
PNF techniques can be used to:
- develop muscular strength and endurance
- Facilitate neuromuscular control and dynamic stability
- Facilitate proprioception, mobility, coordinated movements, and restored function
- Facilitate passive, active or active‐assisted range of motion
87
Once adequate flexibility and strength have been achieved, PNF may be used to improve:
coordination, timing, endurance and speed of movement
88
In PNF, Treating on a lower motor level elicits _______.
reflex, automatic or semi‐automatic
| responses
89
In PNF, Volitional responses require high energy and...
use of the higher brain centers
90
In PNF, Treatment is directed towards improving the patient’s...
functional level
91
In PNF,Treatment is directed to the whole _____.
person; Focus on normal patterns of movement
92
In PNF, Treat the stronger side or body part first bc...
it is easier to teach the patient with the unaffected part, can motivate them and it has an influence on the problem area
93
PNF requires use of ______ senses to integrate the motion
ALL
94
sensory input to the nervous system will affect..
motor output, specific input yields specific output
95
kinesthetic input:
touch, pressure, resistance, approximation/distraction of joints and stretch
96
In PNF, Strong muscle groups _____ the weaker muscles groups of the pattern
facilitate
97
In PNF,Movements may be done unilaterally or...
bilaterally (asymmetrically, symmetrically or reciprocally)
98
Irradiation:
treating the stronger body part causes overflow of energy into involved
part, trunk, limb
99
Manual contact: contact on the skin stimulates skin receptors that facilitate...
background tone in the muscles directly underlying the point of contact
100
Applying pressure to the skin overlying groups of muscles, tendons and joints that are responsible for moving the body part help...
facilitate movement in the desired direction..
- contact over agonist facilitate the pattern
- contact over antagonist inhibits the pattern
101
Quick stretch reflex:
facilitates tone in a muscle using the monosynaptic quick stretch reflex; muscle elongated, doctor briskly stretches muscle facilitate tone/strength in a muscle that Is inhibited, weak or fatigued from exercise
102
monosynaptic quick stretch reflex:
muscle elongated, doctor briskly stretches muscle facilitate tone/strength in a muscle that Is inhibited, weak or fatigued from exercise
103
Approximation Facilitation Technique=
compression of joint surfaces facilitates muscle tone around a joint via joint receptors; generally reserved for weight‐bearing joints
104
Quick approximation:
helps promote extension and stability of the joint
105
Maintained approximation:
sustained joint compression facilitates a volitional, learned extension response
106
Contraindications for Approximation Techinque:
painful areas and non‐weight bearing joints
107
Fitness:
a level of cardiovascular functioning that results in heightened energy reserves for optimum performance and well being (may also include strength and flexibility)
108
Endurance:
the ability to work for prolonged periods of time and the ability to resist fatigue (measure of fitness‐it includes muscular endurance and generalized cardiovascular endurance)
109
measure of fitness‐it includes muscular endurance and...
generalized cardiovascular endurance
110
Maximum Oxygen Consumption (VO2max):
measure of the capacity of the aerobic or oxygen system of the total body and is the max volume of oxygen consumed per minute.
111
What is the best single measure of cardiovascular reserve and physical fitness?
Maximum Oxygen Consumption (VO2max)
112
Conditioning:
dependent upon exercise of sufficient intensity, duration and frequency. Causes the person to adapt and increases their level of endurance
113
Adaptation:
cardiovascular system will perform more efficiently as a result of endurance exercises
114
Maximum Heart Rate:
the heart rate measured at the highest exercise intensity during a maximal exercise test
115
Training (target) heart rate:
the exercise heart rate at which conditioning takes place. It is usually expressed as a percentage of the maximal heart rate and is therefore a submaximal heart rate
116
Aerobic Goals=
1. Enhance physical work capacity
2. Decrease submaximal working HR
3. Lower the resting HR
4. Lower systolic and diastolic BP
5. Increase coronary blood flow, collateral circulation
6. Improve skeletal muscle energy production
7. Decrease serum triglycerides and increase high density lipoproteins
117
Additional Benefits of Aerobic Exercise=
1. control of body fat
2. increase resistance to fatigue and extra energy
3. tone muscles and increase lean body mass
4. decrease tension and aid in sleeping
5. increase general stamina
6. psychological benefits (improve mood, mental alertness, self esteem and well being, reduce depression, anxiety and stress)
118
Reversibility of Benefits...
- 2 weeks: significant reduction of work capacity can be measured
- months: benefits gained can be lost within several months
119
frequency and duration to maintain a level of fitness is ____ than that required to improve it
less
120
Purpose of PARQ...
1) provide info about the safety of starting the program
2) provide info about risk factors associated with cardiovascular disease so lifestyle education can be implemented
3) develop an exercise prescription that will maximize benefits and minimize risk
121
Exercise Program Mode of Activity:
an activity that uses large muscle groups, can be maintained for prolonged period of time, is rhythmic and aerobic nature (walking, running, dancing, swimming etc.)
122
Exercise Program Intensity=
intensity must overload the cardio and muscular systems
123
once adaptation has occurred, the training intensity must be _____ for further improvement
increased
124
exercise of a high intensity for a _____ time gets more improved VO2max than exercise of moderate intensity for a longer time
longer
125
VO2max is a function of ______.
intensity
126
What is Aerobic Activity linearly related to?
Heart Rate
127
What can be used as measure of intensity?
Heart Rate
128
What % of max HR is needed for conditioning to occur?
range of 55‐90% of max HR (55‐70% for sedentary, 70‐85% for generally healthy adults, 85‐95% for athletes)
129
The _____ the intensity of exercise the shorter duration needed and vice versa.
greater
130
A 20 to 30 min conditioning session is usually optimal at __% max HR
70%
131
What is the optimal frequency of exercise?
3‐4 times per week
132
What kinds of exercise should a rehab program start with?
Initially light calisthenics and low level aerobic activities minimize muscles soreness and avoid injuries and discomfort
133
As conditioning occurs, the HR will _____ for a given intensity.
Decrease; HR is one of the best indicators that the exercises should be adjusted
134
It will typically take ______ weeks to see measurable effects from blood work
6‐8 wks
135
Generally initial conditioning will take from ___ wks.
4-6 wks; Continued improvement for 4‐5 months
136
Maintenance usually begins after the first _____ months of exercise.
6mo
137
What happens if a Pt continues the same workout indefinitely?
maintains fitness even if improvement is minimal
138
What is the purpose of the warm up period?
to enhance the adjustments the body has to make to meet the demands of the activity
139
Warm up period characteristics=
10 min duration, total body movement exercises, gradual and mimic the exercise activity, sufficient for person to break a sweat, doesn’t cause fatigue or reduce
energy stores, HR within 20 beats per minute
140
Physiological Effects of the warm up period (get ready)=
```
‐increase muscle and core temp
‐decrease lactic acid formation
‐increase circulation
‐shift blood from visceral to sk msl
-increase efficiency of msl contraction
‐increased need for oxygen
‐increased nutrients to muscle ‐decrease musculoskeletal injury
‐dec. muscle viscosity
‐inc. metabolism
‐increase venous return
‐increase need for oxygen‐inc. pulmonary circ. And dec. pulm vascular resistance
‐inc. nerve conduction
‐inc. oxygen to muscles
‐increase mental alertness
```
141
Exercise period mode=
continuous, submaximal, rhythmic, repetitive, dynamic exercise of large muscle groups sustained for prolonged periods without exhausting the oxygen transport system
142
Exercise period intensity=
depends upon the patient’s physical condition generally THR begins at 55‐70% of MHR
143
Exercise duration=
usually 20‐30 min, not including warm up or cool down; 3‐4x/wk
144
Exercise Progression Guidelines...
- initial Conditioning stage:4‐6weeks
- Improvement conditioning stage: 4‐5 months
- Maintenance stage: begins at 6 months
145
What is the purpose of the exercise cool down?
prevent pooling of blood in extremities, prevent fainting, enhance recovery
period, prevent myocardial ischemia, arrhythmias and/or cardiovascular complications
146
How long is exercise cool down?
5‐8 mins, total body movement exercises
147
What are the physiological effects of the cool down?
muscles maintain venous return, increase blood return to heart and brain as cardiac output and venous return decrease, oxidation of metabolic waste and replacement of energy stores
148
Arm vs. leg exercises:
arm exercises have a higher caloric expenditure bc they are less mechanically efficient
149
isotonic exercises=
isotonic: increase the capillary to muscle fiber ratio by opening the existing unused capillary channels and buy imposing a demand to make new ones
150
isometric exercises=
isometric: create a large increase in BP which places increase strain on the heart and is undesirable during aerobic exercise
151
Submaximal Work Capacity:
ability to perform less than maximal work for prolonged periods of time; aerobic exercise increases submaximal work performance
152
What are the associated Hormonal Changes of exercise?
those that conserve water, prevent decreases in blood glucose and that make fats more available as fuel
153
Interval Training:
marked physiological demand for advanced conditioning training, reserved for well conditioned athletes
154
work to recovery ratio:
suggested 1:3 cycle: 1 min work cycle followed by 3 min recovery
155
What demographic does Water Aerobics Exercises?
popular with those who have joint pain, injuries, trouble keeping their balance
156
Water Aerobics=
allows exercise to many muscles and joints at same time, heart beats lower so more activity and higher intensity can be tolerated, water decreases body temp., decreases stress on joints and muscles
157
Postural muscles tend to contain ____ muscle fibers.
type I
158
What type of muscle fibers are best for endurance?
Slow twitch fibers have a high level of endurance and are better since postural muscle require relatively constant contraction.
159
______ have a low threshold of recruitment.
slow twitch fibers
160
Phasic muscles tend to contain _____ muscle fibers
type II
161
Fast twitch fibers=
produce motion and action and require more strength and speed for their purpose. They have a higher threshold of recruitment.
162
muscle performance cannot improve unless?
muscle is taxed beyond usual daily activity
163
overloading is the action of...
imposing additional demand beyond ADLs, regardless of what system is involved
164
Exercise intensity should be at least ___% of maximum to stimulate strength
60%
165
Training Threshold=
point of the overload at which the body adapts to increase its ability to perform
166
Training Adaptation=
‐the period of time the body goes through changes in response to stress after exercise
‐usually around 12‐48 hours
167
Law of Facilitation=
“when an impulse passes through a certain set of neurons to the exclusion of others, it will take the same course on future occasions and each time it traverses this path, the resistance in the path will be less.”
168
The nervous system sets up abnormal facilitated pathways that are cyclic and are manifest by ______.
spasm, ischemia, hypoxia, pain, muscle weakness and joint instability
169
Facilitate pathways must be resolved to obtain...
any degree of permanency in rehabilitation
170
Approx. 20% of neurological motor output “crosses over” to _____.
the same soft tissues of the inactive joint
171
Training Overflow=
a muscle is strengthened 15 degrees on either side of the exercise range
172
Specific Adaptation to imposed demand (SAID)=
‐adaptations only occur in the cells that are stressed by the overload
‐specific types of exercise result in specific types of responses
‐training benefits are specific to the movement, speed and position used in training
173
Can strength once achieved be maintained by using a lower intensity program?
Yes
174
More ____ twitch fibers are lost during short term decrease in activity.
SLOW; compared to fast twitch fibers
175
Strength is lost at what rate?
one‐third the rate of gain; What is gained in one month will be lost in three months if training stops
176
REP=
a single completed exercise movement that consists of one complete movement towards a direction of exertion and the controlled return back to the starting position
‐failure of any part constitutes an incomplete rep and is not counted
177
SET=
a single series of exercise movements with no rest in between‐also called a “bout”
178
“trick” exercise movements=
recruit overactive synergists that substitute for joint stabilizers
179
What happens if quality of movement pattern is not maintained during training?
substitution patterns are only reinforced providing no therapeutic gain to the patient
180
Functional Training Range (FTR)=
range which is painless (or centralizing), appropriate for the task at hand and which does not cause muscle substitution
181
As muscle and joint function improves, pain should _____.
decrease; If not need to re‐e evaluate to rule our red flags or yellow flags
182
increased strength is measured in..
both muscle bulk and number fibers activated
183
Exercises must be somewhat job/lifestyle specific; must be _______ through all ranges of motion.
pain free
184
Isometric exercise (iso=same; metric=measure):
‐no change in muscle length
‐resistance=the force acting on it
‐increase BP
‐increase strength ‐no agility is gained
185
Types of Isometric contractions:
muscle setting, resisted isometrics, stabilization exercises
186
Muscle Setting=>
low intensity, used in phase 1 of injury, doesn’t improve strength, can retard muscle atrophy, held for 10 seconds
187
Resisted Isometrics=>
against resistance, develop strength w/o joint movement, 60‐80% max effort needed to develop strength; contractions performed every 20 degrees of joint range for 10 seconds
188
Stabilization exercises=>
used to develop joint and postural stability, contracts several groups of muscles on all sides of a joint in mid‐range, require 25‐50% max effort, hold for 10 seconds
189
Isotonic Exercise (iso=same, tonic=tone):
‐changes muscle length and moves the joint
‐resistance remains fixed and the speed of movement varies
‐strength, power and endurance can be improved
190
Concentric contraction:
AKA “positive” exercise, the muscle shortens as it moves the joint
191
Eccentric contraction:
aka “negative” exercise, muscle lengthens as it moves joint, produces greatest amount of muscle tension (strength), increase cardiovascular stress, increased DOMS
192
Isokinetic Exercise (iso=same, kinetic=motion):
‐machine controlled, speed is constant but resistance varies
‐aka “accommodating resistance exercise”
‐can be done in either concentric or eccentric mode
‐increases muscle strength, power and endurance
193
“accommodating resistance exercise” is aka ______ exercise
isokinetic
194
Can isokinetic exercise be done in either concentric or eccentric mode?
oh yea
195
Effects of tubing exercises:
‐increased size and strength of muscles, reduced muscle atrophy, pain relief, increase facilitation and velocity of muscular contraction, increased joint endurance, reduced healing time, decreased adhesions
196
Limitations of tubing:
- tubing continues to increase resistance at the end of the exercise range instead of decreasing resistance
- resistance cant be easily or accurately measured
197
Can tubing exercises cause undue strain on muscles and joints?
yes
198
Advantages of tubing:
exercise can be applied to a specific joint or muscle contraction range; inexpensive, portable and easy to use
199
Elasticity of tubing lends itself to doing speed contractions which train for improving _______.
muscle reaction time and power
200
Tube Strength Overflow:
muscle is strengthened 15 degrees on either side
201
Tube Exercise Law of facilitation:
each time the neurological path is traversed, resistance is lowered
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Principle of crossover:
approx.. 20% of neurological motor output “crosses over” to the same soft tissues of the inactive joint
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Velocity Spectrum:
most functional activities occur at high velocities, typical isotonic exercise occurs at approx.. 60 degrees/sec and is very ineffective in strengthening muscles and joints at functional speeds required by every day activities
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What are the benefits of high velocity activities (faster speeds)?
Faster speeds decrease joint compression, faster speeds increase joint fluids, nutrition, lubrication and fluid viscosity
205
What are the five Phases of tubing and Physiological Benefits?
Phase I: slow speed/mid range (short arc)
Phase II: fast speed/mid range (short arc)
Phase III: slow speed/ full range
Phase IV: fast speed/full range
Phase V: functional training;
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Tubing Phase I=
slow speed/mid range (short arc)
| ‐orthopedic patient: 60 seconds or until fatigue
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Tubing Phase II=
fast speed/mid range (short arc) ‐orthopedic patient: 60 seconds or until fatigue
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Tubing Phase III=
slow speed/ full range ‐orthopedic patient: 60 seconds every other day
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Tubing Phase 4=
fast speed/full range ‐orthopedic patient: 60 seconds every other day
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Tubing Phase 5=
functional training; perform above phases using movements that mimic the activity, job or sport to which the patient is returning
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What happens if a patient breaks form or substitutes movement during exercise?
they are considered fatigued and exercise is stopped
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straight single plane motions are used prior to _____.
rotational motions
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T/F: bilateral exercise is always preferred
Troof
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perform exercises w/o pain or breaking form for ____, then progress to next phase
one minute
215
It generally takes ____ weeks to progress to the next phase of exercise.
2 weeks
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If a patient does not progress to the next phase in one week, then have them do exercises _______ instead of daily
every other day
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Why are exercises done bilaterally?
to take advantage of cross‐education
218
T/F: PNF patterns can be used along with tubing
True (gain benefits of both)
219
______ exercise just outside unstable range offers proprioceptive training
fast mid‐range
220
Eccentric contractions; assist the limb being exercised through the concentric phase and have the patient perform _____.
the eccentric phase very slowly
221
Free weight advantages=
increase # of motor units, inc. frequency of neural firing, inc. muscle facilitation, produces muscle hypertrophy, speed can be varied for training, relatively inexpensive
222
Free weight disadvantages=
doesn’t fully exert muscle, momentum can be used, potential for injury, time consuming
223
Variable resistance machines:
| Advantage=
inc. # of motor units firing, inc frequency of neural firing, develops type I slow twitch fibers, produces muscle hypertrophy, good for eccentric, stretches the muscle
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Variable resistance machines:
| disadvantage=
cannot do speed contractions, doesn’t fully exert the muscle, very specific movements and can’t be changed, expensive and occupies space, not sure if its better than free weights
225
Elastic Tubing Advantages=
can operate at different speeds, can affect many directions of movement, may be very specific form and isolate muscles, inexpensive, mobile and large space not needed
226
Elastic Tubing disadvantages=
difficult to use, doesn’t match muscle force, resistance continues to increase as muscle contracts, strain joints if not done properly, cannot be easily measured in pounds
227
Isokinetic Exercises Advantage=
can match force angle with appropriate resistance, good evaluative tool
228
Isokinetic Exercises disadvantage=
motion is controlled and patient is strapped in, high costs, money, space, time, trained personnel needed
229
Isometric Exercises Advantage=
simple, inexpensive, can be used on an unstable or injured joint, increases strength, holding isometric contraction for 6 sec is 90% as effective as holding for 30 sec
230
Isometric Exercises Disadvantage=
time, must be performed every 20degrees of joint motion, muscle is strengthened only in the range which it was exercised, not as much muscle strength can be achieved as isotonic
231
Holding isometric contraction for 6 sec is ____% as effective as holding for 30 sec
90%
232
Most ADL’s require ______contractions.
dynamic rapid
233
In isometric exercises the greatest gains are made in the _____ state of conditioning
lower
234
Value of Active‐Resistive Exercise (ART)
* Aids in prevention of overuse injuries
* May increase the integrity of soft connective tissue and bony tissue and decrease injury (inc. metabolism, tissue thickness, tissue weight, and strength)
* Damage ligaments regain strength faster with ART
235
Bone‐ligament junction strength is _____ with endurance training
increased
236
Value of Active‐Resistive Exercise (ART)
- Articular cartilage receives increased nutrition
- Increases tensile strength of collagen tissue
- Prevents a decrease in bone loss
- Decrease muscular pain
237
We rely on sensory feedback for information about such things as:
Electromagnetic fields. Gravitational field. Reactive pressure from the ground.
238
Even after strength, endurance, flexibility have been established, inadequate retraining or poor integration of neurological systems may result in ______.
ligament and joint dysfunction
239
Balance, Coordination, Dynamic Stability, Static Stability and Posture are controlled through integration of afferent input from three systems and regulation of appropriate efferent output:
* Visual System.
* Peripheral Vestibular System (Semicircular Canals, Otoliths).
* Somatosensory System (Proprioception, Cerebellum).
240
______ are of no use in darkness, and may be counter‐ productive when the visual field moves markedly, as in motion sickness.
visual afferents
241
The _____ systems contribute input to reflexes.
visual, vestibular, and somatosensory; When one system breaks down, the central nervous system relies upon the other two systems
242
Poor balance has been correlated with:
Low back pain Neck pain Ankle instability and sprain Knee instability Osteoarthritis Ataxia
243
Center of Gravity:
Acts vertically downwards, towards the center of the earth.
244
Balance Base of Support:
Composed of the two feet and the area between them.
245
Stability:
When a line from the center of gravity to the ground falls within the base of support.
246
Ground Reaction Vector:
Force (reaction) of the ground on the body
| A function of the center of gravity and muscles on the joints of the body.
247
The mechanism the nervous system uses to control sway...
Ground Reaction Vector
248
Strategies to Control Postural Sway in the Sagittal Plane (A‐P):
Ankle Strategy: Gastroc‐soleus and anterior tibialis act first.
Hip and Knee Strategy: If ankle strategy is inadequate.
Corrective Step: If all else fails, a step (postural reflex) regains stability.
249
Strategies to Control Postural Sway in the Frontal Plane (Medio‐Lateral):
Hip Strategy: Hip adductors and abductors move body from side to side.
Ankle Joint: Peroneal and posterior tibialis muscles may be activated.
Flailing Arm Movements, or Sideways Corrective Step: Postural reflexes.
250
What receives information on posture and movement from the vestibular apparatus, spinal cord and visual system?
the cerebellum
251
T/F; The cerebellum uses information from the utricle and saccule of the inner ear to compute instructions on balance and stance.
Troof
252
Data is transmitted to the motor output areas in spinal cord aka?
cerebello‐spinal tracts
253
Reciprocal feedback from muscle stretch receptors via ascending _____ tracts.
spino‐cerebellar
254
Vestibular Apparatus:
Connects with higher brain centers affecting gaze mechanisms via medial longitudinal fasciculus, which then connects with the cord and brainstem to affect balance directly.
255
T/F: Vestibulospinal tracts make a direct connection to the spinal cord.
T
256
________ regulate sensory cells making them more or less excitable.
Motor systems
257
the reticular system is responsible for..
general arousal in higher animals
258
Sensory information reaches the conscious cortical levels after processing in what region?
the thalamus.
259
_____ initiates movements with help of the cerebellum and basal ganglia, which refine the crude motor plans of the motor cortex.
The cortex
260
hard‐wired reflex mechanisms are built right into the ______.
spinal cord
261
_____ travels through the medial longitudinal fasciculus, read nucleus and pons to the vestibular system and cerebellum.
Visual input
262
What commonly produces imbalance?
Neck extension; reduces horizontal visual input, places vestibular receptors in a disadvantageous position
263
Patients who rely heavily upon visual input for balance will complain of difficulties when:
Walking on thick carpet in a dark room.
Walking on the beach at night.
Walking down the inclined floor in a dark theater.
Walking on uneven surfaces such as grass or gravel.
264
By itself ocular input has no reference point for the central nervous system so it cannot determine if...
the input is from movement of the body, environment, or the eyes.
265
Perception of Motion:
Ability to distinguish between motion of self and environment.
266
Poor Perception of Motion:
Orient to motion in environment unrelated to body’s motions. Patients will not perceive themselves as stable as they orient to the moving objects around them.
267
Gaze‐stabilization:
keeps a visual image stable on the retina while the head is moving.
268
What requires input from the Vestibulo‐ocular reflex and the peripheral vestibular system?
gaze stabilization
269
What are common uses of gaze stabilization?
Walking when it keeps the horizon stable during heel‐strike.
Allowing one to read a line of print or a billboard while the head is moving.
Allows one to focus on something as one is walking past.
270
_____ dysfunction limits the ability to focus vision on one spot during the normal head movements while walking.
Vestibular
271
Smooth Pursuit:
The ability to move the eyes while focusing on a target as it moves across the visual field.
272
What is needed in order for smooth movement to occur?
Input from retina, cervical mechano‐receptors, vestibular apparatus, cerebellum, cervical and extrocular muscles is highly coordinated to allow a
273
Saccade:
Quick, darting movements of the eyes designed to focus the eye on an object of interest.
274
Saccade can be elicited by...
visual stimuli, sound, verbal commands, tactile stimulation, or memories of locations in space.
275
What requires intricate coordination of cervical muscles and cerebellum to initiate and brake eye‐ head‐neck movements?
saccade
276
What may affect saccade and cause blurred vision?
Cervical dysfunction; Common in cervical spine injuries such as whiplash.
277
Cervico‐Occular Reflex:
• Maintains fixation of the eyes on a target with movement of the neck. • With head and neck movement, cervico‐ocular reflexes keep eyes in place for ocular stability.
278
What reflex occurs as the head is turned in one direction and the eyes move in the opposite direction to the same degree with the same velocity to maintain fixation of the eyes?
Cervico‐Occular Reflex
279
Vestibulo‐Occular Reflex:
• Purpose is the same as cervico‐ocular reflex: To maintain eye position with that of the head.
280
_____ is a more powerful influence on eye movements than the cervico‐ocular reflex.
Vestibulo‐Occular Reflex
281
Optokinetic Reflex:
The visual system interprets movement of objects across the visual field as movement of the head, and the optokinetic reflex compensates for this by moving the eyes in the opposite direction of perceived head movement.
282
The ______ reflex moves the eyes in the opposite direction of perceived head movement.
optokinetic
283
Three Semicircular Canals: Perpendicular to each other detect...
Angular Acceleration: Head Rotation or Change in Velocity Along a Curve.
284
Utricle and Saccule (Otoliths) located in the Inner Ear detect...
Linear Acceleration: Change in Velocity Along a Straight Line: e.g., Gravity.
285
Doll’s Head Response:
Eyes fixated on a spot and will move in a direction opposite to head movement (Vestibulo‐ocular reflex).
286
Without upper cortical brain, eyes move like...
a doll whose head is turned (super creepy)
287
Can Vestibular disorders be unilateral or bilateral?
both
288
Unilateral disorders:
Tends to more dizziness from an imbalance between the two vestibular systems.
289
Bilateral disorders:
♦ Dizziness is not as prevalent due to less imbalance between the two systems.
♦ Pronounced disequilibrium is present.
290
Secondary symptoms of vestibular disorders include...
```
Difficulty with perception of integrated sensory input.
♦ Depression
♦ Anxiety
♦ Mental Confusion
♦ Emotional Instability
♦ Cognitive Dysfunction
♦ Chronic Fatigue
♦ Muscle Tension
♦ Headaches
```
291
PROPRIOCEPTION:
```
Forces of Gravity
Static Position
Movement in space
Direction of movement
Speed of movement
Compression on joints
Length of muscles
```
292
What is the location of SOMATOSENSORY MECHANORECEPTORS?
```
♦ Skin
♦ Muscles
♦ Tendons
♦ Ligaments
♦Joint capsules
```
293
MUSCLE SPINDLES:
Respond to changes in muscle length.
Maintain muscle tone and appropriate tension in muscles on opposite sides of a joint.
Basic “wiring” to maintain and relax proper joint alignment and upright posture.
294
Where is the Highest concentration of muscle spindles?
Interspersed within the contractile fibers of all skeletal muscles. Most are in the central portion (belly) of each muscle
295
Where are GOLGI TENDON ORGANS located?
Located in the junctions of muscles and their tendons.
296
What exert an inhibitory effect on contraction of the muscle fibers?
golgi tendon organs
297
What can rapidly inhibit a muscle contraction in order to protect the tendon?
golgi tendon organs
298
JOINT MECHANORECEPTORS:
Variety of sensory nerve endings in tough, fibrous tissues that surround and protect all
joints.
299
Where are Type I mechanoreceptors found?
found in higher densities in the proximal joints
300
Type I mechanoreceptors:
♦ Sense position of joint: signal joint angle through normal ranges of motion.
♦ These help determine postural (tonic) muscle contractions.
301
Where are Type II nerve endings located?
densely distributed through the distal joints
302
Type II nerve endings:
♦ Adapt to changes in position
♦ Affect phasic muscle actions.
♦ Most active at onset and termination of movement.
303
What Require considerable joint stress at end ranges before firing?
Type III mechanoreceptors: high‐threshold
| ♦ Require considerable joint stress at end ranges before firing.
304
Where are Type IV receptors located?
free nerve endings in ligaments, capsules, articular fat pads.
305
Type IV receptors:
♦ Respond to pain stimulus
♦ Generates intense, motor responses in all muscles related to a joint
♦ Results in the protective muscle contractions that restrict joint movement.
306
irreversible changes in jts after _____ wks of immobilization;
8 weeks; CT is restricted, cant withstand normal loads and degenerates;
