Topic of the Town
An individual who has Diabetes (T2) is coming to the clinic for a work conditioning program. What would be cut-off values for blood glucose that would be a contraindication for starting exercise?
Looking for 2 numbers.
<90 or >250 mg/dL = blood glucose values
(Literature varies: <70-90, >250-300)
During a large breath, all trunk muscles are involved. Describe what occurs during an exhale at the abdominals, pelvic floor, and diaphragm.
Large exhale: Abdominals move posteriorly, diaphragm moves superiorly, and pelvic floor moves superiorly
Your patient is an 8-year-old boy who fell out of a tree and broke his leg. Upon taking vitals, you note his RR is 24 breaths/min but no other sx/signs of distress. Is this normal?
What's a normal range for an adult & school-age child?
Yes. ~30 would be a cutoff for concern (literature varies)
Adults: 12-20; Adolescents: 12-16
Children: School age (6-12) 18-30
Preschool children: (2-6 years) 22-34
Most literature suggest this as a cut-off score for injury risk with FMS testing
14
Name 4 of the 6 realms of wellness discussed by Bezner et al. and discussed in class.
Social, emotional, physical, psychological, intellectual, spiritual
An individual with POTS dx is performing table exercise, but upon standing, begins to feel funny. Their initial HR was 72, but upon standing is now 105 bpm. What is the next best response?
Bonus: What does POTS stand for?
- Have pt sit down, take BP and monitor heart rate for next 10-minutes prior to returning to exercise
Postural orthostatic tachycardia syndrome
You try to challenge your patient's stability during a lunge activity by having them perform a Runner's lunge (like we did in Yoga Lab) with a bicep curl combo movement. You notice they are working hard to maintain stability and perform the exercise. How should you advise them to inhale/exhale to be more efficient in their exercise?
Inhale: during the lowering of the lunge (eccentric)
Exhale: during the pressing up from the lunge (concentric) when the bicep curl (concentric) portion occurs
You are taking your new patient through their first warm-up emom on the bike, and they have a hx of TIAs. Afterwards, they complain of some chest discomfort and SOB. Upon taking their BP, you note the following: 165/110. They state their BP has always been high and they are taking medication. What is your next move?
Stop exercise, 110+ DBP is considered not safe for exercise. Given other sx, refer to ER.
Document, monitor patient, follow-up with MD.
What is the first movement for testing order for the Y balance test?
Right anterior
Having possession of a clear sense of self-identity and a positive sense of self-regard is referring to which realm of wellness?
Hint: noting if your patient is self-aware and confident can help you determine their health in this area.
Emotional
Your patient is taking Linsiopril, an ACE inhibitor. You want to start working them a little harder in the clinic, progressing to more WB activities. You start next session with a 5x squat, 5x hip hinge, 1 lap side-step warm-up, followed by a more demanding PT session, and then a 5 minute walk on the treadmill as a cool-down. Why should the cool-down be monitored closely?
Cool-down: These patients are more at-risk for post-exercise hypotension; a gradual cool-down can help mitigate risk and should be done in the clinic for safety of the patient post-session if more exercise was performed.
Diaphragmatic breathing and pursed lip breathing are both very similar. However, the purpose of each is different - what is the main purpose behind each?
Diaphragmatic: strengthen the diaphragm
Pursed lip: aid with SOB, decrease work of breathing, slow down and control breathing
You want an individual to be working at 70% of their max HR in order to be working "moderately" during their RTW circuit. The individual is 35 years old. How do you determine their target heart rate for the session?
220-35 = 185
185 x (0.70) = ~130 bpm
A composite score or standardization for the Y balance test needs what additional measurement?
Leg length
Describe 2/6 of the "skills" that PTs should be able to do when screening for nutrition and weight management
1) BMI screen, 2) ask specific questions on diet/water intake (ie: Do you drink 6-8 glasses of water per day; do you eat 5 servings of fruits & veggies?) and providing information and guidance when answer is no, 3) role modeling healthy habits, 4) screening for malnutrition and obesity, 5) counseling & motivational interviewing skills, 6) ability to recognize and refer out
You have been treating your patient with osteopenia for low back pain, and they return to PT and report their most recent T-score was a -2.8.
Knowing this, what types of exercise may you want to generally stay away from?
Name 2.
High-impact activities, excess spinal flexion activities, spinal flexion + rotation
You are initiating Box breathing for your patient who exhibits a noiciplastic-dominant pain mechanism and is struggling with multiple stressors outside of PT. Describe how to do this as if you were talking to a patient.
Breathe in for 4 seconds, hold for 4 sec, exhale for 4 seconds, hold again for 4 seconds
Repeat 3-4x
2-4x/day
Your 42-year-old male who is recovering from his total knee has been doing well in PT. You are starting to work into more WB exercises and work on getting his HR up during the session. You did not take a resting BP at the Eval nor at the start of the session, but decide to see where he's at during his rest-break. His BP is: 200/80 - is this normal?
Yes- SBP can go anywhere from 180-240 mm Hg during exercise depending on the intensity.
>200 may require more attention as risk can increase here for cardiac events*
Ideal to have a resting- for every increase in workload, a 10 mmHg rise is normal.
This FMS test is most depending on dorsiflexion when determining a score between a 2 and a 3
Squat
What is the difference between positive and negative stress when it comes to stress management wellness screening (described by Bezner et al. 2015)
Positive stress (eustress): temporary; helps promote well-being and growth, often around challenging or exciting situations or experiences
Negative stress: Prolonged exposure to the body's stress response due to poor coping mechanisms or prolonged exposure to a toxic situation/experience
You recommend aquatic PT for your patient who has been experiencing chronic low back pain for 8 years, and has been having trouble with land PT. This patient also has a dx of hyperthyroidism. You want to brief your co-worker, a PTA, who will be working with this patient half the time. What is a rare but serious complication of this dx, and what are at least 2 sx you should look out for if this happens?
Thyroid storm: fever, tachycardia, dehydration, delirium, irritability
Describe 2 main benefits of nasal breathing vs. mouth breathing, & name 1 population that may struggle with nasal breathing
Nasal: warms & moisturizes air, filters air, slows breath, promotes nitric oxide production
CHD, COPD, those with allergies
Out of the following markers, which increase and which decrease with age?
HR, BP, CO, sleep
HR: increase
BP: increase
CO: decrease
Sleep: decrease
How many of the FMS tests have a specific clearing exam and name them
3 (shoulder mobility, trunk stability push-up, rotary stability)
Is nutrition education within the scope of practice of a PT?
Where is the guidance located on this topic.
Yes!
APTA guide to practice, American dietary guidelines