Flashcards in The Intervention Deck (32):
What is the purpose of the PT intervention?
to safely return a patient to thier preinjury state, with as little risk of reinjury as possible and with the minimum amount of patient inconvenience
How do you return a patient with contractile tissue injury to their PLOF?
through measured rest, rehabilitative exercise, E-stim, aerobics, general conditioning and absence from abuse
How do you return a patient with inert structure injury to their PLOF?
rely more on the level of tension and force placed on them for their recovery, which stimulates the fibroblasts to produce fiber and glycosaminoglycans
What are the 3 components that comprise the physical therapy intervention?
How do clinical prediction rules (CPRs) work?
a cluster of patient characteristics is used to determine the diagnosis, prognosis or likely response to treatment of that individual
Describe the characteristics of an injury in the acute phase
There can be pain at rest, with active motion, or when specific stress is applied to the injured structure.
If the pain is severe it can result in muscle guarding and loss of function.
What does PRICEMEM stand for?
It is how you should treat an acute phase injury
- Manual therapy
- Early motion
What are the goals during the inflammatory (acute) stage?
- avoid painful positions
- improve ROM
- reduce muscle atrophy through gentle isometric muscle setting
- maintain aerobic fitness
What is the subacute phase characterized by?
A decrease in pain and swelling and an increase in pain-free active and passive ROM
What are the characteristics of an exercise load during the subactue phase?
- Volume of training
What are the goals of the subacute phase?
protect the healing collagen, direct its orientation to be parallel to the lines of force it must withstand, and prevent cross-linking and scar contracture
Individuals at lower levels of fitness will respond at a _____ rate and magnitude of adaptation than when they posses higher levels of fitness
What are the 4 criteria for someone in the subacute stage to advance?
- No complaints of pain
- Full, pain-free ROM
- Good flexibility and balance
- Strength of 75-80% or greater
What forms of manual therapy can be performed during the subactue phase?
- grade II joint mobilization
- friction massage
- gentle contract-relax techniques
Describe the hierarchy of resistive exercise
1) Small arc submax concentric/eccentric
2) Full ROM submax concentric/eccentric
3) Full ROM submax eccentric
4) Functional submax concentric
5) Functional ROM submax eccentric
6) OKCE and CKCE con/eccentric
7) Full ROM submax concentric isokinetic
8) Full ROM submax eccentric isokinetic
9) Functional ROM submax eccentric isokinetic
Why may mild worsening of chronic symptoms be permissible?
because the desensitization of structures may require a mechanical input via stimulation of the large A fibers. However you need to ensure that the increased symptoms do not retrigger the inflammatory response
What is function defined as?
Those activities identified by an individual as essential to support physical, social and psychological well-being and to create a personal sense of meaningful living
What is the ultimate goal of functional training?
restoration of the patient’s confidence
What are the effects of cryotherapy?
- Decrease in muscle and intra-articular temperature
- Local analgesia
- Decreased muscle spasm
- Decrease in edema
- Decrease in nerve conduction velocity
What are the effects of local heat application?
- Dissipation of body heat through selective vasodilation and shunting of blood via reflexes in the microcirculation
- Decreased muscle spasm
- Increased capillary permeability, cell metabolism, and cellular activity
- Increased analgesia through hyperstimulation of the cutaneous nerve receptors
- Increased tissue extensibility
Which produces a greater rise in local tissue temperature, moist or dry heat?
When wanting to reach a depth only up to 2 cm what frequency should you use for US?
When wanting to reach a depth up to 4 or 5 cm what frequency should you use for US?
Intensities of 0.1-.03 W/cm2 are recommended for _____ lesions
Intensities of 0.4-0.8 W/cm2 are recommended for _____ lesions
What are the benefits of US?
- Production of cellular excitation, enhancing cellular activity rather than dampening it
- Enhancing the inflammatory cascade, thereby encouraging the tissues to move into their next phase
- Decreased swelling when applied in a pulsed format during the inflammatory stage of healing
- Stimulation of the active cells and a maximization of scar production activity and quality
- Enhanced modeling during latter stages of healing
What is the goal of phonophoresis?
to drive pharmacologic agents transdermally into subcutaneous tissues
In what type of patients should you use static traction?
- Patients with joint and/or nerve root irritability
- Patients with reasonable developing neurological signs that have been associated with irritability
- Patients with severe arm pain combined with reduced neck movement toward the painful side
In what type of patients should you use intermittent traction?
- Patients with an acute joint derangement
- Patients requiring generalized joint mobilization
- Patients with pain coming from muscle spasm
What is prolotherapy?
the injection of a small volume of an irritant solution at multiple sites on painful ligament and tendon insertions and in adjacent joint spaces to allow rapid production of new collagen and cartilage through stimulation of the immune system’s healing mechanism
What is sclerosing therapy?
The injection of abnormal vessels that are associated with painful tendons with a sclerosing agent to decrease pain