Ultrasound
Name 3 regions that would benefit from a frequency of 3 MHz
Superficial structures - wrist, clavicular region, knee/ankle joint areas, cervical muscles, etc.
What HR and BP values would be deemed "unsafe" for beginning exercise?
HR: >120, <40
BP: >180 SBP, >110 DBP
Hct will typically increase due to decrease in plasma volume from fluid lost. It takes longer for Hct changes to occur, PV changes occur acutely.
Name 3 contraindications for STM
Malignancy, fractures, contagious skin disease/condition, acute infection or inflammation, high or present DVT risk, prolonged bedrest
Name 2 conditions/impairments that require specific positioning evaluation and education
Burn victims, contractures, amputees, spasticity/rigidity, limited post-op independence
Name 2 of the 3 mechanical effects of US
stable cavitation, acoustic streaming, microstreaming
If a patient begins exercise with a BP of 132/80 and upon exercising, you notice a BP reading of 120/80, what is the best next step?
Stop exercise, Determine if the patient has any signs or symptoms of ischemia (chest pain/pressure, SOB, excess sweating/fatigue, palpitations)
In order to maximize the immune response and immune health, what type of exercise is considered "best"
Moderate aerobic exercise
- repetitive strenuous exercise has less positive effects on WBC count, exercise-induced immunosuppression has been documented
Name 3 things a PT should do in order to set themselves up appropriately for performing IASTM/STM
clean hands, proper draping for pt for privacy and protecting clothing, keeping medium & towel close by for use, never put medium directly on patient- have something to put on hands first then pt, never take hands off pt once tx has begun
Outside of medical conditions/specific pathos, name 3 considerations for assessing positioning in a patient
Level of cognition, Pain and sensation, Strength and mobility, Spasticity, Edema, Infection, Bowel & bladder incontinence, Contractures, Nourishment
Provide 3 reasons as to why a 20% duty cycle may be used
ie: 20% duty cycle - can be used for non-heating effects such as Ca deposit breakdown, break up of scar tissue, promote healing (soft tissue, bone healing), pain (inc blood flow & cell metabolism)
You have a patient who is satting at 93%.
What other symptoms would deem them inappropriate for exercise if they had this lab value? (at least 2)
pallor, wheezing, dyspnea, abnormal HR/RR/BP values
They go to the bathroom and you ask them to assess their urine color- it is light yellow. What are next steps?
Stop exercise. Pt may be suffering from hyponatremia- provide the pt with a Gatorade or juice in order to improve electrolyte levels. Advise to consume salty snacks & electrolyte drinks to normalize, see MD/prompt care if sx do not improve with ingestion.
Name 3 benefits of STM
increased blood flow to an area and capillary circulation reduced sensitivity to an area, improve fxn of sweat glands, reducing muscle spasm & fatigue, increase healing rate, psychological relaxation, pain reduction
Describe the ideal positioning for a patient who has LBP that you plan to perform 5-10 minutes of general lumbar STM on
Prone with no pillow under head and a flat pillow underneath the hips, feet hanging off table or small pillow placed underneath shins where feet are not fully plantarflexed
Explain the US parameters that would be ideal for heating of the piriformis for greater pain control and extensibility in a 55 year old with piriformis syndrome
Continuous 100% duty cycle
1MHz
Intensity 1.5-2 W/cm2 (2-10cm depth, 1-1.5 is <2cm)
5-10 min for 2x ERA
You are working with a 33 yo T2 DM patient who has been sent to PT for deconditioning and has a personal and health-related goal of weight loss. Y
ou want to educate this pt on how to gauge activity workload, and where an optimal cardiovascular training zone for weight loss might be so they can continue a walking/cycling program.
What HR would be ideal for them to reach if wanting to work at 60-70% workload?
HRMax: 220-33 = 187
187 x .60 = 112 bpm (minimally)
A 72 yo individual who is being seen by PT in the hospital post-stroke is getting ready for DC. Upon reviewing labs, you notice their CO is a 3.6 L/min value. Are they safe to exercise/return home for PT?
Yes, CO normally decreases with age. This is considered normal for this pt.
Explain the difference of effleurage and petrissage concepts for use of STM in PT
Effleurage- introducing your hands/touch to the patient and providing initial warmth to the body
Petrissage - when pressure & depth is applied, but not as locally or as intense as friction, the "main" of the actual STM for tx
If a pregnant patient is unable to lie prone, what is the second best position for treating the lumbosacral region?
L sidelying
- better than R as to not compress IVC (inferior vena cava)
- Allows for tissues to not be maximally stretched in a flexed fwd sitting position
Name 4 contraindications to US:
malignancy, pregnancy*, use over spine/eyes, active infection, pacemaker/implants, impaired sensation or cognition
You are working at your first clinical, which happens to be right next to a local school. You have a 10 year old and a 14 year old on your caseload. You note that the older one has an RR around 23-24 breaths/min. Is this normal?
Yes, preschool children have a norm of 20-30, older children 16-25, adults 12-20
What is a strategy for T1 DM patients to use prior to leaving the clinic to prevent onset of delayed or nocturnal hypoglycemia? Why/how?
Describe 2 areas/scenarios that would benefit from MFR
- post-ops (once healed), post-trauma, postural abnormalities, thoracic pain/TOS, diaphragm excursion, joint hypomobility, later stages of burn/wound fascia/skin mobility
A 45 yo patient had a stroke ~2 weeks ago and has significantly limited mobility in her L side (UE & LE) and has some moderate neglect of the L side. She is also in the ICU now due to a recent pneumonia infection. Knowing this, what would be 2 important factors to consider with positioning this patient?
- L side neglect, Significant L sided weakness, potential cognitive concerns, immobilization for prolonged period of time, pneumonia infection