Procedures 2

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Author:
kellymillerSPTA
ID:
167847
Filename:
Procedures 2
Updated:
2012-09-07 08:15:53
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Therapeutic exercise
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Description:
ROM Flexibility
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  1. Examination
    • required before any intervetion can be implemented.
    • has to be done for tx to be legal.
  2. History
    Systems review
    Test and measures
    • Cardiovasular/pulmonary
    • Integumentary
    • Musculoskeletal
    • Communication/cognition
  3. Evaluation
    thought process that accompanies each and every examination
  4. Diagnosis
    • a cluster of signs, symptoms, syndromes and categories. Decision reached as a result of evalutation.
    • we give a physical therapy diagnosis (musculoskeletal) to know what to treat
  5. Prognosis
    • the predicted optimal level of improvement in function and the amount of time needed to reach that level.
    • not all pt will reach 100% but all should improve, if not pt is not canadite for physcial therapy or clinician is doing something wrong
  6. Intervention
    specific procedures to accomplish goals
  7. Patients with same pathology experience individual differences in how that pathology is manifested. Individual treatments take into consideration:
    • stage of healing
    • severity of injury
    • method of immobilization
    • pain
    • age
    • co-morbidites
    • psyhco-social status
  8. Definition of Orthopedics
    the correction of deformities of muscles or bones
  9. Definition of Biomechanical Rest
    decrease in forces/controlling forces that contribute to pathology
  10. Aspects of physical function
    • balance/postural control/equilibrium
    • stability
    • cardiopulmonary fitness
    • neuromuscular control/coordination
    • muscle performance
    • flexibilty/mobility
  11. Stress and forces are applied in a controlled progressive and appropriately executed mannor to
    reduce physcial impairments and improve function
  12. Prescription of therapeutic exercise
    • depends on the needs of an individual patient
    • data collect MUST occur first
  13. 3 Important priniples in the application of resistance exercise
    • overload principle
    • SAID principle
    • reversibility principle
  14. Motor learning
    • each patient has a distinct level of ability to learn new exercise
    • -this is based upon awarness, cognition, coordination, experiences, pain, pathology, and physiology
  15. Primary Categories of Therapeutic Exercise
    • ROM
    • Stretching
    • Resistive Exercise
    • endurance trainning
    • balance
    • mobilization
  16. Safety
    • Review medical chart and history
    • medications
    • enviroment
    • quality and control of exercise
    • cognition
    • handouts
  17. Determinants
    • Mode
    • Alignment
    • Stablization
    • Intensity
    • Volume (reps & sets)
    • Frequency
    • Duration
    • Rest Interval
    • Speed
  18. Dosage of exercise is compromised of all the paramenters by which a muscle can be overloaded
    • Intensity
    • Volume
    • Frequency
    • Duration
    • Rest Interval
  19. Continuum of ROM to restore Strength
    • PROM
    • AAROM gravity reduced
    • AAROM
    • AROM gravity reduced
    • AROM
    • Resistive Exercise
    • Specific Training
  20. Full ROM depends on
    • joint integrity
    • normal extensibility of soft tissues around joint
  21. CPM
    • Continuous Passive Motion
    • passive motions performed by a mechanical device
  22. CPM Benefits
    • lessening of effects of immobilization in condition such as:
    • decreased adheasions, contractures, stiffness
    • stimulates healing of tendons and ligaments
    • enhances healing of incisions over the moving joint
    • increases synovial fluid lubrication and rate of cartilage healing and regeneration
    • faster return of ROM
    • decreases post-op pain
  23. Indications of CPM
    • CPM may be used in acute stage if it doenst increase pain or inflammation
    • fractures
    • surgical release of contractures and adheasions
    • total knee arthroplasty
    • post op ACL repair
  24. Components of mobility
    • joint integrity
    • extensibility/flexability
    • neuromuscular control
  25. Adhesion
    occurs when scar tissue joins togetehr 2 seperate, mobile parts, which can limit the smooth movemtn and result in hypomobility
  26. Contracture
    adaptive shortening of soft tissues which result in significant resistance to passive or active stretch and limits motion
  27. Flexability
    amount of movement or measurement of movement
  28. Contraindications to stretching
    • boney block
    • unhealed fx
    • inflammation
    • when stretching would disrupt the healing process
    • hematoma/bleeding
    • acute stage
    • when shortened tissues provide stablility or improve function
  29. What load is best for intensity of stretching
    • low load
    • bc it minimizes muscle guarding contractions
    • less chance of damage to tissue
    • better at elongating dense ct in chronic contractures
  30. What are the 4 modes of stretching?
    • manual
    • self-stretching
    • mechanical
    • neuromuscular inhibition
  31. Generally accepted progression of a scar
    • 8 weeks < adaptable
    • 8-14 weeks gradually less adapatable
    • >14 weeks scar is mature
  32. In normal tissue there is no adaptive shortening of
    capsules or ligaments
  33. Resistance Exercise
    any form of active exercise in which a dynamic or static muscle contraction is resisted by an outside force
  34. 3 componets of muscle performnace
    • strength
    • endurance
    • power
  35. 1-2 weeks of strength gains are
    neurological, not from adaptive hypertrophy of mm
  36. strength gains take
    6-12 weeks
  37. Overload
    demands beyond the normal load are needed to have training effects on mm, load muscle beyond metabolic capacity
  38. Reversability
    trainning effects begin to fade within 1-2 weeks after trainning stops
  39. DOMS symptoms
    • pain
    • swelling
    • tenderness
    • reduced ROM
    • stiffness
  40. Theories of cause of DOMS
    • latic acid build-up: NO
    • tonic muscle spasms: NO
    • torn tissue: probably
    • connective tissue damage: probably
    • tissue fluid
  41. Speed of Exercise
    • slow and controlled
    • needs to match fuctionality as close as possible
    • too slow/too fast=fatigue
    • LE in gait= 240 degree/sec
  42. Periodizaation
    breaking down training calendar into cycles which correlates to performance and rest times
  43. Intergration into function
    • balance of stability and mobility
    • balance of strength, power, and endurance
    • progression of movement process
  44. MODE has many dimensions
    • form of resistance- manual, mechanical, constant or variable
    • type of contraction- isometric, eccentric, concentric
    • position- WB NWB
    • aerobic or anaerobic
    • short or full arc
  45. Short arc VS. Full arc
    • full- better strengthening
    • more functional
    • higher risk
    • more fatiguing
  46. Manual exercises
    • allow direct feedback
    • when joint motion must be carefully controlled

    • Limitations: strength of therapist
    • not objective measure of resistance
  47. Mechanical Exercises
    • many types can be used in variety of conditions
    • quantitative measurement
    • machines offer heavy resisitance
  48. Isometric exercise
    • contractions where little or no movement occurs
    • light isometrics keep mm fibers mobile
    • heavy isometrics can build strength
  49. Concentric resistive exercise
    • simple
    • cross -over effect
  50. Eccentric resistive exercise
    • can be easier for weak muscles
    • prevention of injury
    • more DOMS
    • more complex exercise
    • greater tension developed
  51. Open Kinetic Chain (OKC)
    • good for specific mm strengthening
    • more control of specific movement
    • less chance of unobserved subsitutions
    • often used early in rehab
  52. Closed Kinetic Chain (CKC)
    • increased joint stability 2 degrees joint approximation
    • co-activation of PM&antagonist increases stability
    • improve balance/upright control
    • more task specific/functional
    • increases neuromuscular control, proprioception, kinesthesia
  53. Contraindications to resistance training
    • Pain
    • inflamation in neuromuscluar disease
    • acute joint inflammation
    • severe cardiopulmonary disease
  54. PRE's Delorme Method
    • 3 sets of 10
    • 1st set =50% max
    • 2nd set= 75% max
    • 3rd set = 100 max
  55. PRE's Oxford Method
    • 3 sets of 10
    • 1st=100%
    • 2nd=75%
    • 3rd=50%
    • takes fatigue into consideration
  56. PRE's DAPRE (knight) method
    4 sets of variable resp using an established 6RM
  57. Isokinestic Exercise
    • isolate motion or muscle
    • specific speed training
    • expensive
    • cumbersome
    • may be too aggressive
  58. Isokinetic Exercise (accommodating resistance)
    • it involves a constant velocity at a pre-selected rate
    • resistance varies to match the force through-out ROM
  59. Plyometrics (stretching-shortening drills)
    uses stretch reflex and elasticity properties of mm

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