Week 3 (EXAM 2) Flashcards

Question

Provide an example of AAROM

Answer 1

Lymphedema is not a disease. It is a result of something that has occurred with the body that has caused a malfunction in the lymphatic system. While you may not be able to cure or fix lymphedema, you can help a patient manage lymphedema to live a full and active life.

Answer 2

A) congenital: Presents at birth. May be termed Milroy's Disease. B) Praecox: Develops prior to 35 years old. C) Tarda: Develops after 35 years old.

Answer 3

This type of lymphedema is much more common to see in the clinic and is most commonly related to comprehensive oncologic management, particularly of the breast, pelvis, and abdomen. Secondary lymphedema is classified by the cause of the injury. 1) Surgery: Lymph nodes and vessels may have to be surgically removed for primary tumors affecting the lymphatic system or for metastatic tumors that spread through the lymphatic system. The physicians are trying to stop the spread of the tumor cells. Lymph node sampling and subsequent removal (if tumor cells are found) in the upper extremity is common in breast cancer surgeries. Pelvic or inguinal lymph nodes may have to be removed for treatment of pelvic or abdominal cancers. In order to preserve the major lymph nodes, patients will often have imaging to trace potential tumor development and what is called sentinel nodes. Sentinel nodes are like soldiers on the front line. They are the warning nodes. The main lymph nodes affected all the way to the sentinel nodes have to be removed, because the sentinel nodes are the lymph nodes that have some detectable trace of cancer cells. If these nodes are removed along with any affected main lymph node, there is a much better chance now that the axillary or main lymph nodes may be spared as long as the tumor cells are not there. If tumor cells are found in the major lymph nodes, these nodes must be removed, and the patient has a higher likelihood of developing lymphedema. 2) infection and inflammation: Lymphangitis is inflammation of the lymph vessels, and lymphadenitis is inflammation of the lymph nodes. Enlargement of the lymph nodes is nermed lymphadenopathy. These can all occur as the result of an infection or local trauma, and they can all cause disruption of lymph circulation. 3) obstruction or fibrosis: There are a lot of things that can clog up the lymphatic system, including trauma, surgery, and neoplasms. Radiation therapy used to treat malignant tumors can cause fibrosis of lymphatic vessels, even long after the physical treatment has ceased. 4) Combined Venous-Lymphatic Dysfunction: Chronic venous insufficiency and varicose veins lead to stagnation within circulation. If the venous system is not returning blood, it is certainly not returning lymph very well; this is because the lymphatic system has increased workload imposed over time, which decreases the efficiency of the lymphatic system. Because this is a combination of venous and lymphatic dysfunctions, you might see a combined clinical presentation. Common with venous dysfunction, the patient may have dependent edema, which means the swelling is present when the limb is hanging in a gravity-dependent position. These patients can report a dull aching or tiredness in the affected extremity, and you might see varicose veins and bulging veins. The patient may also have hyperpigmentation of the skin. For the lymbadema portion of this presentation, the patient may have pitting edema, particularly in the dorsal aspect of the foot with swelling in their toes.

Answer 4

Chronic venous insufficiency and varicose veins lead to stagnation within circulation. If the venous system is not returning blood, it is certainly not returning lymph very well; this is because the lymphatic system has increased workload imposed over time, which decreases the efficiency of the lymphatic system. Because this is a combination of venous and lymphatic dysfunctions, you might see a combined clinical presentation. Common with venous dysfunction, the patient may have dependent edema, which means the swelling is present when the limb is hanging in a gravity-dependent position. These patients can report a dull aching or tiredness in the affected extremity, and you might see varicose veins and bulging veins. The patient may also have hyperpigmentation of the skin. For the lymphedema portion of this presentation, the patient may have pitting edema, particularly in the dorsal aspect of the foot with swelling in their toes.

Answer 5

1) pitting edema 2) brawny edema 3) weeping edema

Answer 6

This is the most severe and long-duration form of lymphedema, where fluid leaks from cuts or sores. The patient's ability to heal these wounds is significantly impaired. This usually occurs in the lower extremity.

Answer 7

Pressure on the edematous area feels hard with palpation, which means that there is development of fibrotic tissues.

Answer 8

When you press on the edematous tissue with your fingertips, there is an indentation of the skin that persists for several seconds after the pressure is removed. Bad thing is that there is edema, but the good thing is that there is little to no fibrotic changes since the tissue can Rebound

Answer 9

A) Stage 0 (Latency Stage): The lymphatic system is impaired, but there is no visible swelling. The body compensates, and symptoms like heaviness may be present. B) Stage 1 (Reversible Stage): Swelling is mild and soft (pitting edema) and reduces with elevation. It’s reversible with proper care. C) Stage 2 (Spontaneously Irreversible): Swelling becomes more persistent, with tissue hardening (fibrosis). Elevation doesn’t reduce swelling, but management can control it. D) Stage 3 (Lymphostatic Elephantiasis): Severe swelling, skin changes (thickening, hardening), and a high risk of infections. Management focuses on preventing complications.

Answer 10

Self-manual lymphatic drainage (MLD) is a gentle massage technique used to stimulate the lymphatic system and promote the movement of lymph fluid, reducing swelling and improving circulation. The process involves light, rhythmic strokes applied in a specific direction, typically toward lymph nodes, to encourage drainage. It’s essential to begin at areas near major lymph nodes, such as the neck, armpits, or groin, to “clear” pathways before addressing swollen areas. For example, to reduce arm swelling, start by massaging the lymph nodes in the neck and underarms with gentle circular motions, then use light sweeping strokes from the fingertips toward the armpit. Always consult a healthcare provider before starting MLD to ensure proper technique and safety.

Answer 11

Typically, in presence of a joint dysfunction (the joint gets stuck), the muscles and soft tissue can respond with increased reactivity, guarding, and feeling "knotted up." Once that joint dysfunction is corrected, the soft tissue mobility improves Now consider the other reason that muscles and soft tissues demonstrate reactivity: a chemical build-up. Improvement of the joint mobility in that region can improve the electrochemical balance in the region, as well as improve the neuro reflexes in the region. Some patients may require soft tissue techniques first. You may find they would benefit from soft tissue techniques first when you try to "wind up" a joint during mobilizations/manipulations and there is not a good increase in tension in the joint. If you do not feel this increase in tension, you know the joint mobilization/manipulation techniques will not be as beneficial as you planned. In that case, you may do a small amount of soft tissue, and then immediately address the joint again. An increase in joint tension is like when you need to pop your knuckles. You bend your finger joint "tightening" the joint until there is a release or "pop." Essentially, if possible, treat the cause of the muscle issue which can often be an underlying joint issue. However, at times you need to address the muscle first because it is so restricted that you cannot appropriately address the joint. It is a bit of a "chicken or the egg" paradox.

Answer 12

Functional movement pattern techniques in physical therapy focus on integrating passive and active associated movements while addressing mobility restrictions through soft tissue or joint mobilizations. These techniques combine guided passive motions, where the therapist facilitates movement, with active patient participation to engage relevant muscle groups and improve motor control. Simultaneously, therapists may apply soft tissue mobilization (e.g., massage or myofascial release) or joint mobilization to reduce stiffness, enhance range of motion, and optimize the quality of movement. For example, during a squat retraining exercise, a therapist might perform ankle joint mobilizations while the patient actively practices proper squat mechanics to improve mobility and motor patterning simultaneously.

Answer 13

1. Myostatic Contracture A myostatic contracture occurs when a muscle shortens due to a lack of stretching or prolonged immobility, without structural changes in the muscle fibers. It is typically reversible with consistent stretching and strengthening exercises. Example: A person with tight hamstrings from prolonged sitting can regain normal flexibility through regular stretching routines, such as seated hamstring stretches or dynamic warm-ups. 2. Pseudomyostatic Contracture Pseudomyostatic contracture is caused by increased muscle tone or spasticity due to a neurological condition, like a stroke or cerebral palsy, leading to apparent stiffness. Treatment focuses on reducing tone through techniques like neuromuscular inhibition or botulinum toxin injections. Example: A stroke survivor with spasticity in the biceps may undergo physical therapy that includes passive stretching and muscle relaxation techniques, such as proprioceptive neuromuscular facilitation (PNF). 3. Arthrogenic Contracture An arthrogenic contracture results from intra-articular pathology, such as joint adhesions, capsular restrictions, or cartilage damage, which limit the joint’s range of motion. Addressing the underlying joint issue is crucial for recovery. Example: A patient with knee stiffness after surgery may benefit from joint mobilizations and stretching exercises to improve range of motion, such as passive knee flexion and extension stretches.

Answer 14

1. Periarticular Contracture A periarticular contracture occurs when tissues surrounding a joint, like ligaments or the joint capsule, become stiff and restrict movement. Therapy targets improving soft tissue flexibility and joint mobility. Example: A frozen shoulder (adhesive capsulitis) may be treated with shoulder mobilizations, passive stretching, and soft tissue work to improve joint capsule flexibility and restore motion. 2. Fibrotic Contracture A fibrotic contracture involves irreversible structural changes in muscle or connective tissue, such as excessive fibrosis or scarring, that permanently restrict motion. While full reversal may not be possible, therapy can focus on improving function and preventing further stiffness. Example: A patient with chronic Achilles tendon fibrosis may benefit from therapeutic interventions like deep tissue mobilization, eccentric strengthening, and bracing to maximize functional movement.

Answer 15

Stretching is a therapeutic intervention used to increase available range of motion in which a tensile force is applied at the end of motion. This results in elongation of the muscle-tendon unit. This deformation is transient, meaning that the changes due to appropriate stretching will not be permanent just by the stretching alone.

Answer 16

This is the most common method of stretching we think of. The soft tissues are elongated just beyond the point of tissue resistance and then held in the lengthened position with a sustained stretch force over a period of time. Benefits: Safer than ballistic stretching with less tension created in the muscles; can be performed manually or mechanically Down-sides: Does not seem to trigger the GTOs (Golgi Tendon Organs) to inhibit the muscle like we would like to think that they do

Answer 17

A static stretch where the tissues are held in a comfortably lengthened position until a degree of relaxation is felt by the patient or therapist. The shortened tissues are then incrementally lengthened even further and again held in the new end-rage position for an additional duration of time. In other words, you take the patient to where they feel a stretch, hold it in that position until the tissues relax or give a little, then take the joint/segment into further range in the same direction. Repeat as needed. This method takes advantage of the viscoelastic properties creep and stress-relaxation. Benefit: Maximum effectiveness for static stretching Downside: Takes a lot to control the stretch into new ranges of motion; takes still to be able

Answer 18

Dynamid stretching involves controlled movement through the active ROM for each joint. These are different from ballistic stretches because of the controlled movement and the decreased velocity. Benefits: Can lead to enhanced muscle performance if the dynamic stretch is performed for more than 90 seconds. Beneficial for athletes, and may have an appropriate role in general fitness and rehabilitation programs. Downside: Can be very difficult to teach patients how to do this at an appropriate speed with appropriate control.

Answer 19

Short-duration stretch that is repeatedly but gradually applied, released, and then reapplied multiple times during a single treatment session. The endrange force is applied at a slow velocity, in a controlled manner, and at a relatively low intensity. What makes it different from static-progressive stretching (hold 30-60 seconds) is that cyclical stretching is only held for about 5-10 seconds each time. What makes it different from ballistic stretching is the low intensity and slow velocity. Benefits: As effective or more effective than static stretching in the literature, and tends to be more comfortable. One study showed decreased tissue yield with cyclical stretching, and another study hypothesized that the heat given off with cyclical stretching caused the soft tissues to stretch more easily.

Answer 20

Ballistic stretching is a rapid, forceful intermittent stretch. It has high-velocity and high-intensity. I like to think about it as getting a "running start" to the stretch. Benefits: Improves flexibility equally to static stretching Downside: Causes greater trauma to stretched tissue and greater residual muscle soreness; not recommended for elderly or sedentary individuals or patients with musculoskeletal pathology or chronic contractures. See page 99 for reasoning.

Answer 21

PNF stretching is also called active stretching or facilitative stretching. We try to integrate active muscle contractions into stretching to inhibit or facilitate muscle activation. This increases the likelihood that the muscle to be lengthened remains as relaxed as possible during stretching. The thought is that this technique works to increase ROM because of proprioceptive input to the muscues to allow it to move. The other thought is that there is autogenic inhibition of the same muscle thorugh muscle spindles in the affected muscle OR there is reflexive inhibition by asking the antagonist muscles to work. Again, more of this will come at the end of the semester. You need to know that PNF techniques will ask the antagonist or the agonist muscle to work a little bit to get the joint to move better

Answer 22

If you intend for this to be a muscle self-stretch for the triceps/elbow extensors, your prescription would be: * Mode: Self-stretch to muscle * Intensity: Moderate stretch sensation * Duration: Hold 45-60 seconds, 4-5 repetitions * Frequency: Daily

Answer 23

proliferative

Answer 24

Minimal to the first point of feeling stretch

Answer 25

Motor coordination

Answer 26

Rhomboid major

Answer 27

Blocked order practice

Answer 28

The right patellar pain is the primary impairment, and the loss of hip strength/motor coordination is the secondary impairment. Primary impairment: direct impairment as a result of the issue Secondary impairment: abnormalities due to primary intervention Composite impairment: combo of both

Answer 29

Reduce sensory input from tissues

Answer 30

not necessarily

Answer 31

Personal factors because there in no proof of physiologic issues causing the feeling (otherwise activity limitation)

Answer 32

1) Mechanical: Joint mobilizations can restore joint play, stretch out taut capsules, stretch out adhesions, snap adhesions, and alter positional relationships. 2) Neurophysiological: Remember how Grade I and Il mobilizations are best at addressing pain and muscle guarding? The reason that they address pain so well is because they activate Type I (Ruffini) and Type II (Pacinian) mechanoreceptors. This repeated activation decreases pain. Type Ill mechano receptors (Golgi) are activated either by joint manipulation or a strong, endrange stretch to the capsule, thereby providing reflex muscle relaxation. 3) psychological: The actual act of laying your hands on a patient with confidence helps calm a patient and assures them that something good will result. This is NOT a reason that we would choose to use a mobilization or manipulation, but we have to consider it. Think about it like this, most people appreciate or sense confidence with a solid handshake or firm hug. Most people feel creeped out by a floppy, weak handshake or hug. The same is true with joint mobilizations and manipulations. What you need to take home from this is that you need to be confident in yourself in order to effectively deliver a manual therapy technique.

Answer 33

In tissues that are acutely irritated, have high levels of pain, or early on in the rehabilitation processes, you will want to plan to start joint mobilizations in the open-packed joint position. As the patient's pain decreases, joint mobility increases, or time has passed, you can progress joint mobilizations into more of a closed-packed position to take advantage of the tissue wind-up.

Answer 34

A muscle energy technique (MET) refers to any mobilization that involves the voluntary use of the patient's muscles. Think about it like PNF combined with joint mobilizations (see videos of soft tissue lower extremity techniques).

Answer 35

* "Restore mobility of a joint segment, * Retrain movement patterns * Reduce edema, * Stretch fibrotic tissue, * Retrain the stabilizing function of intersegmental muscles"

Answer 36

* "When the endfeel is predominantly muscular and not capsular * To relax patient i.e. prior to manipulation * Following manipulation (direct action) * Prevent further joint stiffness"

Answer 37

To restore joint mobility, the technique involves accurate localization of the motion barrier and specific muscle activation to encourage a joint to move either into the barrier of motion or away from the barrier of motion. The resistance provided by the therapist is very gentle, and the dosage involves about 3 repetitions for a 6-8 second hold. This is really, really important to know!

Answer 38

1) Mode: Muscle Energy Technique, either agonist or antagonist muscle involvement. 2) Intensity: Very, very light resistance (ounces, not pounds of force). PT needs to be sure the opposite or additional surrounding muscles are not trying to fire and help, which can lead to excessive compression. 3) Duration: Hold 6-8 seconds, performing 3-4 repetitions. Recheck your objective measure. 4) Frequency: As needed depending on if patient meets one of the criteria for when to use the technique: * When the endfeel is predominantly muscular and not capsular * To relax patient i.e. prior to manipulation * Following manipulation (direct action) * Prevent further joint stiffness"

Answer 39

"A muscle energy technique is applied from a precisely controlled position, in a specific direction and against a distinctly executed counterforce. The counterforce is in the region of ounces, not pounds. For a muscle energy technique to be successful, proper localization is key. This makes MET's not the easiest techniques to do as palpation skills need to be fairly well advanced."

Answer 40

Grade 1-2 (for pain)

Answer 41

1. Manual lymphatic drainage Slow, very light repetitive stroking and circular massage movements in a specific sequence (clear proximal congestion and then stroke distal to proximal toward lymph nodes) with the involved extremity elevated. See lab videos for demonstration. 2. Compression therapy Depends on the phase of treatment. Phase 1 – low stretch bandages are used (low resting pressure) with nonwoven padding with or without foam padding used day and night Phase 2 – low stretch bandages are used at night, with compression garments during the day Summary bandages are used to reduce limb volume; garments are used to maintain limb size 3. Exercise a. Deep breathing and relaxation exercises b. Flexibility exercises c. Strengthening and muscle endurance exercises d. Lymphatic drainage exercises

Answer 42

(hip flexor shortness)

Answer 43

(hip extensor tightness)

Answer 44

convex mobilization will have stretch (example joint capsule ant/post) in the same direction of force concave mobilization will have stretch in the opposite direction of force

Week 3 (EXAM 2) Flashcards

(281 cards)