Week 2 (EXAM 1) Flashcards
(82 cards)
1
Q
What is the ultimate goal of therapeutic exercise?
A
achievement of an optimal level of symptom free movement during basic to complex physical activities
2
Q
What is the typical order of events for clinical reasoning?
A
3
Q
what are the components of therapeutic exercise?
A
systematic, planned performance of physical movements, postures, or activities intended to provide a patient/client with the means to:
- Remediate or prevent impairments of body functions and structures.
- Improve, restore, or enhance activities and participation.
- Prevent or reduce health-related risk factors.
- Optimize overall health, fitness, or sense of well-being.
4
Q
What are the components of function?
A
muscle performance
Cardiopulmonary endurance
Mobility/flexibility
Stability
Balance/postural equilibrium
Neuromuscular control/coordination
5
Q
Define balance
A
ability to align body segments against gravity to maintain or move the body (COM) within the base of support without falling
6
Q
Define cardiopulmonary endurance
A
ability to perform moderate intensity, repetitive, total movements (running, swimming, …) over an extended period of time
(Same term as cardiopulmonary fitness)
7
Q
Define coordination
A
correct timing and sequencing of muscle firing along with appropriate intensity to guide movement
8
Q
Define flexibility
A
ability to move freely, without restriction, used interchangeably with mobility
9
Q
Define mobility
A
ability of body structures to move or be moved to allow ROM for functional activities (functional ROM)
10
Q
Define muscle performance
A
capacity of a muscle to produce tension and do work
11
Q
Define neuromuscular control
A
interaction of the sensory and motor systems that enables synergists, agonists, and antagonists, as well as stabilizers to anticipate or respond to proprioceptive or kinesthetic information and perform the task
12
Q
Define stability
A
The ability of the neuromuscular system through synergistic muscle actions to hold a proximal or distal body segment in a stationary position or to control a stable base during superimposed movement. Joint stability is the maintenance of proper alignment of bony partners of a joint by means of passive and dynamic components.
13
Q
What are the effects of insufficient and inappropriate stress on the human movement system?
A
1) Inappropriate or insufficient stresses lead to impaired movement systems. Excessive load or forces can cause acute injuries, like sprains, strains, or fractures. Excessive loads can also cause chronic conditions, like stress reactions in bones or tendinopathies.
2) Insufficient loads can lead to degeneration, degradation, or deformity. An extreme example of this is astronauts in space. The lack of gravity and the long time that astronauts spend on the Space Station leads to significant muscle atrophy and loss of bone mineral density. NASA has had to come up with creative ways to help astronauts impose these stresses on their bodies in order to minimize damage.
14
Q
List components of the ICF model
A
15
Q
Define primary, secondary, and composite impairments
A
Primary Impairments
* Definition: These are impairments that arise directly from the underlying health condition, injury, or disease.
* Example: After a stroke, weakness in the right upper extremity due to neurological damage is a primary impairment.
Secondary Impairments
* Definition: These are impairments that develop as a consequence of the primary impairment, often due to inactivity, compensations, or lack of proper management.
* Example: Contracture of the shoulder joint on the affected side due to prolonged immobility post-stroke is a secondary impairment.
Composite Impairments
* Definition: These are impairments that result from a combination of primary and secondary impairments, often involving multiple systems or contributing factors.
* Example: Difficulty with gait and balance in a post-stroke patient due to a combination of muscle weakness (primary impairment), joint stiffness (secondary impairment), and reduced proprioception (neurological dysfunction as part of the condition).
16
Q
Does solely focusing on the primary impairment address the root cause of the issue?
A
no, addressing the secondary impairments early and concurrently helps address the root cause of an issue by treating the underlying cause
17
Q
What are the steps of critical thinking?
A
18
Q
What are the principles of evidence based practice?
A
19
Q
Describe an outcome oriented model of patient management
A
20
Q
Provide examples of primary movement deficits
A
Mobility Deficits
Movement Coordination Dysfunction/Deficits
Muscle Power Deficits/Force Production Deficit
Referred pain/Radiating pain
General debilitation/poor aerobic capacity
Sensory selection or sensory reweighting deficit
Fractionated movement deficit
Hypokinesia
Hypermetria
21
Q
In which stage of the Patient Management Model will a therapist gather sufficient information about the patient’s existing or potential problems to formulate a diagnosis and determine whether these problems can be appropriately treated by PT interventions?
A
Examination
22
Q
What are distinct elements of a comprehensive examination?
A
Patient’s health history
Systems review
Health and measures
23
Q
What elements should be included in a good PT diagnostic category that will help the therapist develop the prognosis, plan of care, and interventions?
A
Indication of the primary dysfunctions to be addressed in the selection of interventions and development of the plan of care
24
Q
Is a plan of care included in the prognosis?
A
yes
25
A patient presents to a follow-up Physical Therapy appointment 4 weeks after ankle ORIF (open reduction internal fixation). The therapist notes a new, foul odor coming from the patient's surgical site. The therapist notices red streaking on the patient's skin surrounding the Ace bandage used to wrap the surgical site. The therapist notices the wound dressings are soaked in blood with a white/yellow tinge. The patient has a 100.4 deg Farenheit temperature. Based on these examination findings, what should the Physical Therapist do?
Recognize the clinical patterns of an infected wound, refer back to physician, and document.
26
What tool is used to determine whether there are underlying conditions mimicking or making musculoskeletal or neuromuscular symptoms, or other signs indicative of complications that suggest the need for referral?
Review of systems
27
Every test and measure related to the body region on the referring diagnosis should be performed to get the best understanding of the patient's impairments and activity limitations.
False
28
A therapist runs the back of their hands down each side of a patient's spine, and they note that the patient has warmth over the areas of the abdominal organs. Which part of the patient examination is the therapist performing?
Review of systems of the gastrointestinal system
29
What term refers to a prediction of a patient's optimal level of function expected as the result of a plan for treatment during an episode of care and the anticipated length of time needed to reach specified functional outcomes?
Prognosis
30
Which phase of the Patient Management Model involves the analysis and integration of information?
evaluation
31
Provide a goal for mobility deficits, movement coordination dysfunction/deficit, muscle power/force production deficit, referred/radiating pain, general debilitation/poor aerobic capacity
32
What type (mode) of exercise is appropriate to prescribe for each goal?
33
What is the intervention ladder?
34
How can edema affect her?
1. Edema, which will produce loss of muscle power, motor coordination, and ROM
2. Pain, result of edema and tissue injury/intensity from the ligament tear
3. Decreased ROM, due to edema
4. Movement coordination dysfunction, due to edema, pain, altered muscle power, and altered mechanoreceptor input. If we look at secondary impairments, there is a strong correlation of patellofemoral subluxations and knee valgus injuries that occur in females, especially with hip motor coordination dysfunctions.
5. Decreased muscle power, due to edema, pain, and loss of ROM
6. Decreased balance and proprioception, due to edema, tissue injury, and altered mechanoreceptor input
7. Activity limitations with gait, transfers, bed mobility, showering/bathing, lifting
8. Participation restrictions in accessing living quarters, accessing classrooms and university services, driving, returning to dance, possibly intramural participation, possibly other recreational physical activity
35
What tests and measures would you want to be sure that you perform at the initial evaluation for primary impairments?
Knee circumfrential measurement
Knee flexion and extension active and passive range of motion
Knee extension MMT
Medial and lateral hamstring MMT
36
What secondary impairments would you want to assess in the Examination portion of this case?
Hip abduction MMT
Hip ER MMT
Craig's Test for femoral version
37
What are some functional tests you would ask this patient to perform?
TUG
6 minute walk test.
5x sit to stand test
38
What activity limitations would you want to assess in the observation portion of the examination?
Sit to stand with and without crutches
Gait assessment
As patient tolerates (probably at Reassessment periods), jumping.
Single limb stance
39
Which of the following self-report measures would you ask the patient to complete?
LEFS
40
Provide an example of a PT diagnosis
S/P traumatic grade II MCL sprain and patellofemoral subluxation producing mobility deficits.
41
should the PT address the acute symptoms or root cause of the issue first?
Treating the acute symptoms first will allow for a more successful treatment of the cause. Once the initial phase of acuity has gone down, aka the swelling has reduced and pain is manageable, you may find yourself aiming to treat the cause of the issue first and any treatments for symptoms may be used more as an adjunct to your primary treatments.
42
Define motor learning
It involves both the ability/development of ability to perform the skill as well as retain the skill. Motor learning involves complex internal processes that allow a person to perform and retain the ability to perform a skill or movement throughout practice. There are true neurologic changes that happen in the central nervous system that organize, process, and affect how motor actions are produced. In a very simple explanation, it is how we develop habits of movement or skills.
43
List the types of motor tasks
Discrete Tasks: These tasks involve an action or movement with a recognizable beginning and end.
Serial Tasks: These tasks involve a set or series of discrete movements that are combined in a particular sequence.
Continuous Tasks: These tasks involve repetitive, uninterrupted movement with no reasonably distinct beginning or end. Although the action may be stopped because of fatigue, the task in and of itself involves repetitions of the same movement.
44
What are the task dimensions that can make it more or less complex?
Environment:
* Closed: Objects around a patient and the support surface do not move. This is a more simple task.
* Open: Objects or other people are in motion AND/OR the support surface is not stable. This is a more complex task.
Intertrial Variability:
* Absent: The environment/condition in which a task occurs is constant (unchanging) from one performance to the next. This is a more simple task.
* Present: Demands in the environment/condition change from one performance to the next. This is a more complex task.
Body Stability:
* Body Stable: The patient keeps their body in a stable, stationary position. This is a more simple task.
* Body Transport: The patient is asked to move from one place to another. This is a more complex task.
Object Manipulation
* Absent: The patient is not asked to manipulate an object, which leaves the hands, and possibly feet, pending the task, free to focus on the task requested. This is a more simple task.
* Present: The patient is asked to hold, carry, kick, manipulate an object. This is a more complex task.
45
What are the stages of motor learning?
46
What are the key components to make practice effective?
* Part practice is appropriate in the early learning stages of complex serial skills with simple and difficult components. It is also appropriate if the patient's cognitive status requires more skill breakdown.
* Whole practice is more effective for learning continuous tasks, serial tasks that require momentum or specific timing, and discrete tasks.
* At the early stages of motor learning, blocked-order practice is most appropriate because it can lead to rapid improvements. It needs to quickly transition to random- or random/blocked practice.
* Blocked practice may still be the method of preference if a patient's cognitive ability is too challenged by random practice, which would interfere with learning.
* Random-order practice leads to better skill retention and generalizability than blocked practice.
* Random/blocked order practice results in faster learning than random-order practice and better retention than blocked practice.
* Mental practice used in conjunction with physical practice enhances motor skill acquisition at a faster rate than use of physical practice alone
47
Define part practice
A task is broken down into separate dimensions. Individual and usually the more difficult components of the task are practiced. After mastery of the individual segments, they are combined in sequence so the whole task can be practiced.
48
Define whole practice
The entire task is performed from beginning to end and is not practiced in separate segments.
49
Define Blocked-Order Practice
The same task or series of exercises or tasks is performed repeatedly under the same conditions and in a predictable order. The task does not change from one repetition to the next.
50
Define Random-Order Practice
Slight variations of the task are carried out in an unpredictable order. The task changes with each repetition.
51
Random/Blocked-Ordered Practice
Variations of the same task are performed in random order, but each variation of the task is performed more than once.
52
Define Physical Practice
The movements of an exercise or functional task are actually performed.
53
Define mental practice
A cognitive rehearsal of how a motor task is to be performed occurs prior to actually executing the task. The terms visualization and motor imagery practice can be used synonymously with mental practice.
54
What are the key components of feedback?
* Intrinsic feedback only involves the patient's sensory systems. There is no feedback from the PT. The benefit is it can provide feedback in the moment or at the end of a task, and it is inherent to everyday life. The limitation is the patient may receive inadequate or impaired feedback and require augmented feedback.
* The therapist provides augmented feedback, which can have several tactile, verbal, visual, or auditory forms. The PT controls the type and schedule of the feedback. Another benefit is that it enhances intrinsic feedback, especially with impaired internal feedback. The limitation is it requires another source of feedback, and it needs to be tapered down. Remember,
"less is better."
* Knowledge of Performance allows patients to recognize and correct components of skills. The limitation is that it does not promote retention of a skill as well as Knowledge of Results.
* Knowledge of Results produces better retention of a skill. The limitation is that a faulty movement or habit may continue to be show up if not corrected.
* Concurrent feedback results in quicker skill achievement, but less effective skill retention that immediate post-response and summary feedback.
* Summary feedback produces better skill retention than concurrent feedback and immediate post-response feedback, but the patient has slower skill acquisition.
* Variable, or intermittent, feedback results in better retention than constant (continuous) feedback, although constant feedback results in better skill acquisition at the beginning stages of motor learning.
55
What are the types of feedback?
1. Intrinsic Feedback
* Definition: Feedback that comes naturally from the patient’s own sensory systems during and after performing a movement. This feedback does not involve external input from the physical therapist or environment.
* Sources:
* Proprioception (sense of joint position and movement)
* Visual feedback (observing their own movement)
* Somatosensory feedback (feeling muscle tension or pressure)
* Auditory feedback (hearing a sound associated with the movement)
* Example: A patient notices that their knee is not bending fully during a squat by feeling stiffness in the joint.
2. Extrinsic Feedback (Augmented Feedback)
* Definition: Feedback provided by an external source, such as a physical therapist, coach, or equipment. This feedback supplements intrinsic feedback to improve motor performance or learning.
* Types:
* Knowledge of Results (KR):
* Feedback about the outcome of the movement.
* Example: A physical therapist tells the patient, “You were able to lift the weight to shoulder height.”
* Knowledge of Performance (KP):
* Feedback about the quality or technique of the movement.
* Example: A therapist says, “You need to keep your back straighter during the lift.”
3. Concurrent Feedback
* Definition: Feedback provided during the performance of the movement.
* Example: While a patient performs a lunge, the therapist says, “Keep your knee aligned with your toes.”
4. Terminal Feedback
* Definition: Feedback provided after the movement is completed.
* Example: After the patient completes a gait cycle, the therapist says, “You were leaning too far forward while walking.”
5. Immediate Feedback
* Definition: Feedback given immediately after a movement.
* Example: A therapist tells the patient, “You didn’t step far enough forward,” right after they finish a step.
6. Delayed Feedback
* Definition: Feedback given after a short delay, allowing the patient to reflect on their performance first.
* Example: A therapist waits a few seconds after the movement before saying, “You need to use your quads more to stabilize the knee.”
7. Summary Feedback
* Definition: Feedback provided after several repetitions of a task, summarizing overall performance.
* Example: A therapist says, “Your first few reps were good, but you started losing form toward the end.”
8. Bandwidth Feedback
* Definition: Feedback provided only when the patient’s performance falls outside a certain range of acceptability.
* Example: A therapist allows minor deviations during a squat but intervenes only if the patient’s knee buckles significantly inward.
56
Explain the M,I,D,F approach
The overall theory related to this intervention prescription is the Physical Stress Theory. We want to appropriately stress the tissues to promote the best healing environment for the tissues. Determining intervention dose requires making choices about variables that apply stress to the tissue.
57
What is the physical stress theory?
The Physical Stress Theory produces Adaptation Responses.
Exercise-induced adaptation is:
* complex process mediated through changes in muscle cell signaling
* Determined by training volume, intensity, and frequency in addition to protein half-life
* Specific to mode of training
Exercise volume: The total amount of exercise performed in a single session.
We need to look at more than just the exercise volume, especially in context of the ICF Model. We need to consider exercise volume + extrinsic factors + psychosocial factors + physiological factors when dosing out our interventions.
What is our goal with the tapping into the Physical Stress Theory?
* To provide safe and sufficient volume of physical stress to produce tissue adaptation without causing tissue injury or death.
58
What are the contraindications and precautions for exercise prescription?
59
What are the stages of tissue healing?
60
When does the inflammatory phase take place? And what are the signs of it?
The first five below are the typical vascular inflammatory response that the patient will feel and may often be noted by the healthcare provider also:
1) Swelling, 2) Redness, 3) Heat, 4) Pain at rest, 5) Loss of function, 6) Physiologically, there is clot formation and phagocytosis of cellular debris
The acute phase is characterized by pain symptoms before tissue resistance with ROM testing:
* Pain and impaired movement are from an altered chemical state that irritates nerve endings, increased tissue tension with edema and effusion, and muscle guarding.
* The body is trying to immobilize and protect itself.
* Acute inflammation typically happens for 48-72 hours, while the acute phase as a whole will typically lasts 4-6 days, unless further insult occurs. "Further insult" can be a macro trauma or a micro trauma. A macrotrauma means a big thing like a fall, slip, impact, quick reaction resulting in injury, etc. A micro trauma is more like wear and tear or continued small insult to an area. An example could be if a person sprains their ankle (macro trauma) but then continues to walk on it with an altered gait pattern (micro-trauma). Microtraumas can build up over time due to faulty movements and result in other issues
61
What is the goal, precaution, and contraindication during the inflammation phase?
Goal of Intervention:
* Maximum Protection
* Control effects of inflammation (remember learning "RICE" for rest, ice, compress, elevate)
* Patient can and should perform nondestructive movements, like PROM, massage, and muscle setting with caution.
* If the injured tissue is in the lower extremity, a good rule of thumb is that if a patient cannot demonstrate normal ambulation, they need an assistive device to support weight-bearing.
* Keep up resistance exercises and functional activities for other tissues as long as the activity does not affect the injured
* Tissue should be optimally loaded. It use to be thought that if injured, then don't use it. However, all tissues, even injured, still need appropriate stress to heal. While the optimal load may be reduced from 100% to 10% or something else, it is always good to still load the tissue when possible unless loading is not safe, such as with a broken bone.
Precautions:
* Be sure to appropriately dose interventions in this phase. Signs of too much movement or increased irritability are increased pain or increased inflammation. Think about a time that you might have rolled an ankle. If you roll it again in a day or two, the swelling becomes even more severe, indicating further injury.
° Muscle setting and massage should be done with the muscle/tissues in a shortened position.
Contraindications:
* Stretching and resistance exercises should NOT be performed at the site of inflamed or swollen tissues.
62
What are the steps to approach the inflammation phase?
63
When does the proliferation phase take place? And what are the signs of it?
* This phase is characterized by repair and regeneration of the tissues.
* Typically lasts an additional 10-17 days after the Inflammatory Phase, but can last up to 6 weeks depending on the tissue(s) that were injured
* Wound closure for skin and muscle is about 5-8 days.
* Wound closure for tendons and ligaments is about 3-6 weeks.
* This is good information to keep in mind, particularly with post-operative rehabilitation.
* Keep in mind that there is no magic wand that says one phase starts or stops. The time frames are good to keep in mind, but look at the tissue healing and response for confirmation of appropriate healing. Additionally, note the phase overlap in the body. There is not hard stop of one phase and a switch to the other.
* Characterized by collagen scar formation within the tissue defect AND pain at tissue resistance.
64
What is the goal, and precaution during the proliferation phase?
Goals:
* Treatment focuses on controlled load to stimulate tissue to remodel in an appropriate direction and minimize effects from immobilization.
* Restore ROM, then functional strength; Initiate and progress non-destructive exercises and activities.
* Appropriately stress the tissues within the tolerance of healing without re-injury or inflammation
Precautions:
* In this phase, the patient feels much better, and the pain is not constant. The patient should expect to feel some discomfort as interventions and activity levels progress, but this discomfort should NOT last more than a couple of hours. Signs that there is too much motion or activity are pain at rest, fatigue in the tissues, increased weakness, and spams lasting beyond 24 hours after the movement/activity.
* Try not to change too many activities in the intervention. If the patient does end up with any of these signs, you might have a lot trouble figuring out which activity was the one that overdid it.
* Eccentric and heavy-resistance exercises, including progressive resistance exercises may cause added trauma to muscle.
These exercises are typically not used in the early part of this stage because the healing tissues have weak tensile strength.
65
What are the steps to approach the proliferation phase?
66
When does the remodeling phase take place? And what are the signs of it?
* Usually, proliferation stops around day 21 (depending on the tissue type), and there is a predominance of fibroblasts that are easily remodeled between days 21-60 (depending on the tissue type...slow it down for tendons and ligaments. They have a poor blood supply so they take longer).
* This phase includes the transition of immature, disorganized collagen to mature, organized Type 1 collagen
* The effects of the organization and return to pre-injury tissue structure are determined by tissue load (thus why optimal loading during all phases is important).
* Think about the SAID Principle from Movement Science 1 (Specific Adaptation to Imposed Demands).
* Differences in Maturation and Remodeling
Maturation refers to the quantity of collagen stabilizing because of the balance between synthesis and degradation. The maturation comes in the quality of the collagen. This can take up to 12-18 months after the injury. Keeping in mind the SAID Principle, remember that the collagen will have maximum strength in the direction of imposed forces.
* Remodeling refers to the breaking of adhesions in the immature collagen molecules from the surrounding tissues. This can occur for up to 10 weeks after the injury. In this phase, the fibers NEED appropriate stress with gentle and persistent treatments to prevent adhesions and forming significant restrictions. At 14 weeks (~3.5 month), the tissue is not responsive to remodeling, and the old scar tissue poorly responds to stretching. Stretching and scar management are critical before the window closes. After this, scar modification is difficult.
* Pain is characterized after tissue resistance.
67
What is the goal, and precaution during the remodeling phase?
Goals:
* Progress exercises that safely stress the maturing collagen for both flexibility and strength so patient can return to prior
level of function.
* Stretch contractures and break or mobilize adhesions.
* Control stresses to progress collagen tensile strength in the necessary directions.
Precautions:
There should be no signs of inflammation. Any discomfort that appears with activity level progressions should not last longer than a couple of hours. Signs of activities/interventions that are progressed to quickly or with too much dosage are signs of inflammation: joint swelling, pain lasting longer than 4 hours, pain that requires medication for relief, decreased strength, or fatigue more easily.
* Unless manual interventions are needed for scar tissue remodeling or restoring joint mobility, ensure the patient takes more responsibility for carrying out exercises in the plan of treatment.
68
What are the steps to approach the remodeling phase?
69
Why is it important to know the appropriate stresses and goals for each stage of healing?
To prevent any damage and provide the appropriate intensity
70
Explain this
1) New collagen never quite returns to the tensile strength it had before. It can get close with appropriate intervention prescription.
2) Notice how shallow the Acute Phase curve is. It does not take much stress to move the tissue into the elastic/plastic/failure phases
3) Proliferative can handle more stress, but strains at an earlier phase. This is why we can be slightly more aggressive in this phase, but we still need to be watchful for signs of tissue damage. Refer back to the signs of inflammation to recognize abnormal response to healing.
4) Remodeling phases work best with appropriate loading and stressing to the tissues.
71
Define chronic inflammation and its causes
Chronic inflammation in its most simple explanation, is the prolonged or recurring pain, activity limitations, and/or participation restrictions that occur as a result of repetitive or excessive stress being imposed on tissues that were unable to respond to the stress. These are usually caused by:
* Overuse, cumulative trauma, or repetitive strain, which leads to repetitive strain overload over time. This will gradually weaken structures, resulting in repetitive inflammation with poor-quality tissue healing. It is very much like the phrase, "The straw that broke the camel's back." You cannot just take off the last piece of straw, and the camel stands up again. The tissues have to go through the healing process for that camel to appropriately stand up again.
* Trauma, especially if it is followed by superimposed repetitive trauma. The condition never had time to progress through phases of normal healing. It also may be the result of too early return to high levels of task demands. Example: You may hear about ankle sprains that "don't heal" or taking a very long time. This could be due to a missed diagnosis or the person going back to activity too soon, causing repetitive trauma to healing tissues.
* Reinjury of an "old scar," which is non-compliant and possibly adherent to surrounding tissues. This will alter force transmission and energy absorption in the area, making the area more susceptible to injury.
* Contractures or poor mobility, which lead to faulty postural habits or prolonged mobility. This can lead to tissues that have abnormal demands or have to make up for other tissues that are unable to tolerate the demands.
72
List the factors contributing to chronic inflammation
muscle length strength imbalance
Rapid or excessive repeated eccentric demand
Muscle weakness
Abnormal bone alignment
Weak structural support
Change in usual task intensity
Too rapid return to activity after injury
73
How do you approach intervention planning when the CC is chronic inflammation?
74
Once chronic inflammation calms down, how can you alter the POC?
75
List examples of types of tissue injury
76
What are the grades of tissue injury?
1) Grade 1 (first degree): Mild pain at the time of injury or within the first 24 hours. Mild swelling, local tenderness, and pain occur when the tissue is stressed.
2) Grade 2 (second degree): Moderate pain that requires stopping the activity. Stress and palpation of the tissue greatly increase the pain. When the injury is to ligaments, some of the fibers are torn, resulting in some increased joint mobility. Definitely plan to include motor control to help control this excessive motion.
3) Grade 3 (third degree): Near-complete or complete tear or avulsion of the tissue (tendon or ligament) with severe pain. Stress to the torn tissue is usually painless (the nerves are damaged), palpation may reveal the defect. A torn ligament results in instability of the joint. You will definitely need to include motor control somewhere in the intervention planning to control this excessive mobility, especially if surgery is not warranted. It may not be the first thing you focus on, but keep it in your mind when you progress the patient.
77
What is the healing time per type of tissue?
78
Define mechanotransduction
(how the musculoskeletal system generates, absorbs, and transmits force)
It is the mechanism by which the cells convert mechanical stimuli into cellular responses. For example, when we appropriately load a healing tissue, mechanotransduction is the process that we are trying to tap into to promote effective tissue healing. It is an ongoing physiologic process.
It is considered to be composed of 3 steps:
1. Mechanocoupling: the direct or indirect physical perturbation of the cell through shear or compression that is transformed into chemical signals within and among cells
2. Cell-to-cell communication - transfer of signaling from one cell to another
3. Effector response - biochemical signals that influence gene expression in the nucleus and promote intracellular processes leading to matrix remodeling
79
List factors that influence treatment and outcomes
* Type of surgical procedure
* Type of tissue involved
* Bone, tendon, ligament, muscle, nerve
* Extent of tissue involvement/damage
* Integrity of involved and surrounding tissue
* Age, health, expectations, and motivation of patient
* Surgeon protocol, if one exists
* Setting of rehabilitation
80
What is the general approach per stage of recovery?
81
What are the goals of post op rehab?
* Initially want to protect the repaired healing tissue while at the same time maintaining mobility and/or strength and functional independence
* Want to introduce a controlled load to the healing tissue to facilitate appropriate tissue alignment and mobility
82
What are some possible post op complications that can occur during rehab?
Pneumonia or atelectasis
DVT
Infection
Delayed wound healing
Failure of fixation device
Rupture of repair
Subluxation or dislocation
Scar tissue formation/adhesions
