PT in the Acute Care Setting/PT for Extremely Weak Pt

Question 1

describe the continuum of care in PT

Answer 1

ER, ICU, step down unit, discharge, acute rehabilitation, skills nursing facility, home PT, outpatient

Question 2

the process of obtaining a history, performing a systems review, and selecting/administering tests and measures to gather data about the pt

Answer 2

examination

Question 3

list 5 things to consider to examine when performing examination

Answer 3

• aerobic capacity/endurance
• CN and peripheral N integrity
• Assistive devices
• muscle performance (strength, power, endurance)
• posture
  (pain, posture, prosthetics, sensory integration, ventilation, self-care, ROM, integumentary system integrity)

Question 4

allow PT, nurses, other healthcare providers to monitor the progress of the pt over time and assess any functional changes

Answer 4

outcome measures

Question 5

list some examples of outcome measures

Answer 5

• Borg RPE
• AM-PAC 6 clicks
• FIM (functional independence measure)
• TUG
• 6 MWT
• 5x STS
• 10 MWT

Question 6

uses 6 questions to assess the function of patients; can be used with a variety of pt populations

Answer 6

AM-PAC 6 Clicks

Question 7

what are the 3 domains assessed in AM-PAC 6 Clicks

Answer 7

mobility
daily activities
cognation

Question 8

used specifically for pts in the ICU; can be used to guide prescription in the ICU as well as measure function

Answer 8

FSS-ICU (functional status score of the ICU)

Question 9

what does the FSS-ICU (functional status score of the ICU) examine

Answer 9

pt ability to:
- roll
- transfer from supine to sit
- sit edge of bed
- transfer from sit to stand and walk
(bed mobility, transfers, ambulation)

Question 10

what do higher scores indicate on FSS-ICU (functional status score of the ICU)

Answer 10

better physical function

Question 11

what are the 3 main types of intervention strategies

Answer 11

restorative
compensatory
preventative

Question 12

directed towards remediating/improving the pt’s status in terms of impairments, activity limitations, participation restrictions, and recovery of function

Answer 12

restorative

Question 13

directed toward promoting optimal function using residual abilities; the activity is adapted in order to achieve function

Answer 13

compensatory

Question 14

directed towards minimizing potential problems and maintaining health

Answer 14

preventative

Question 15

what are the 4 components of exercise training sessions

Answer 15

• warm up
• conditioning
• cool down
• stretching

Question 16

how long should warm up take

Answer 16

5-10 minutes
light to moderate intensity cardiorespiratory and muscular endurance activities

Question 17

how long should conditioning be

Answer 17

20-60 minutes
of aerobic, resistance, neuro-motor, and/or sports activities

Question 18

how long should cool down be

Answer 18

5-10 minutes
light to moderate intensity cardiorespiratory and muscular endurance activities

Question 19

how long should stretching be

Answer 19

10 minutes
stretching exercises should be performed after warm up and cool down phases (dynamic or static)

Question 20

transitional phase; allows the body to adjust to the changing physiologic, biomechanical, and bioenergetics demands placed on it during the conditioning or sports phase of the exercise session; improves ROM; may reduce the risk of injury

Answer 20

warmup

Question 21

allows for gradual recovery of HR and BP; removal of metabolic end products from the muscles used during the more intense exercise conditioning phase

Answer 21

cool down

Question 22

describe light intensity strength training

Answer 22

• 40-50% 1 RM
• 8-10 exercises involving the major muscle groups
• > 1 set of 10-15 reps
• progressive weight training or WB, stair climbing, etc.

Question 23

describe moderate intensity strength training

Answer 23

• > or equal to 2days/week
• 60-70% of 1 RM
• 5-6/10
• 8-10 exercises involving the major muscle groups
• > 1 set of 10-15 reps
• progressive weight training or WB, stair climbing, etc.

Question 24

describe vigorous intensity strength training

Answer 24

• 7-8/10
• 8-10 exercises involving the major muscle groups
• > 1 set of 10-15 reps
• progressive weight training or WB, stair climbing, etc.

Question 25

what decreases with age, making it important to do resistance training in older adults

Answer 25

strength

Question 26

what may need to be precede areobic training in frail adults

Answer 26

muscle strength training

Question 27

individuals with _____ need to increase muscular strength before they are physiologically capable of engaging in aerobic training

Answer 27

sarcopenia

Question 28

describe moderate intensity aerobic training

Answer 28

- > or equal to 5 days/week - 40-60% HRR - 30-60 minutes, at least 10 minute bouts, 150-300 minutes per week - any modality that does not impose excessive orthopedic stress (walking, aquatics, stationary bike)

Question 29

describe vigorous intensity aerobic training

Answer 29

- > or equal to 3 days/week - 60-90% HRR - 20-30 minutes/day, at least 10 minute bouts, 75-100 minutes/week - any modality that does not impose excessive orthopedic stress (walking, aquatics, stationary bike)

Question 30

describe FIIT for balance training

Answer 30

- > or equal to 2-3 days/week - to the point of feeling tightness or slight discomfort - hold stretch for 30-60 seconds - progressively difficult postures that gradually reduce BOS, dynamic movements that perturb the COG, stressing postural muscles, reducing sensory input, tai chi

Question 31

describe neuromotor exercise training and what is it effective in doing

Answer 31

- combines balance, agility, and proprioceptive training - effective in reducing and preventing falls

Question 32

pts who have been on prolonged bed rest and pts in the ICU are especially prone to what

Answer 32

neuromuscular dysfunction and ICU acquired weakness

Question 33

describe the weakness pattern with best rest induced weakness

Answer 33

symmetry LE > UE weakness antigravity muscles most affected

Question 34

describe severity of bed rest induced weakness

Answer 34

weakness is proportional to duration of bed rest

Question 35

are DTR present or absent in bed rest induced weakness

Answer 35

present

Question 36

describe weakness pattern of ICU acquired weakness

Answer 36

symmetric extremity weakness respiratory muscle involvement

Question 37

describe the severity of ICU acquired weakness

Answer 37

weakness is disproportionate to duration of bed rest

Question 38

are DTRs present or diminished in ICU acquired weakness

Answer 38

diminished

Question 39

what do you have to assess with ICU acquired weakness

Answer 39

tone, motor control, strength and sensation

Question 40

what outcome measure can be used to assess ICU acquired weakness

Answer 40

functional status score for ICU (FSS ICU)

Question 41

interventions used on severely weak pt

Answer 41

- progressive mobilization - strengthening - aerobic endurance - balance - flexibility

Question 42

initiated based on pt's tolerance and response to activity, vitals and neurological status must be monitored continuously, consider orthostatic hypotension

Answer 42

progressive mobilization for severely weak pt

Question 43

list some pros and cons for NMES

Answer 43

Strengths: can be used in sedated pts, can be done in supine, single person implementation, provides "something" Limitations: completely non-volitional, current can be impaired by things such as obesity or edema, limited therapist time (takes time to set up), no outcomes beyond ICU awakening

Question 44

what type of training will pts respond better to

Answer 44

interval training better than long periods of activity

Question 45

used to prevent contractures/pressure ulcers, does not prevent muscle atrophy, positioning pts in muscle shortening positions should be avoided especially in pts that cannot move themselves

Answer 45

passive ROM

Question 46

what position helps to correct orthostatic intolerance

Answer 46

exercises in upright positions

Question 47

what is ICU acquired weakness associated with

Answer 47

increased mortality

Question 48

what are the 3 subcategories of ICU acquired weakness

Answer 48

- critical illness myopathy - critical illness polyneurophy - critical illness neuromyopathy

Question 49

what is the best form of management for ICU acquired weakness and what helps to improve prognosis

Answer 49

- prevention is the best form of management - early mobilization improves prognosis

Question 50

what are complications of ICU acquired weakness

Answer 50

- increased time on ventilator - increased time in ICU - increased hospital length of stay

Question 51

general indications for stopping exercise

Answer 51

- onset of angina/angina-like sx - drop in SBP >10 mmHg with increase in work rate - SBP decreases below the value obtained in same position prior to testing - excessive rise in BP (systolic > 250 and/or diastolic > 115) - SOB, wheezing, leg cramps, claudication - signs of poor perfusion (light headed, confusion, ataxia, pallor, cyanosis, nausea, cold or clammy skin) failure of HR to increase with increased exercise intensity - noticeable change in heart rhythm by palpation or auscultation - subject requests to stop - physical or verbal manifestations of severe fatigue - failure of testing equipment