Gait
What are the functional stages of gait?
Weight acceptance, Single limb support, Swing limb advancement
Please explain what PNF is and how it could benefit a patient experiencing decrease motor recruitment as if you were explaining it to a real patient.
PNF = proprioceptive neuromuscular facilitation
Using this technique allows your body and your muscles to re-learn how to effectively activate in proper sequences for certain movements in order to help facilitate your ability to perform functional activities.
Please list the options for electrical stimulation for sensory effects as well as for motor effects and why you might use each.
sensory - TENS, IFC, Premod
motor - NMES, Russian, High Volt
What is the effective radiating area (ERA)
The portion of the transducer that produced sound wave. the area being treated should be 2-3 times the size of the area being treated.
convex (talus) on concave (tibia)
Posterior mob of the talus on the tibia.
How much knee ROM is required for normal gait mechanics?
0 degrees - 60 degrees
Please explain the joint positions for D2 flexion/extension of the LE
Flexion:
- hip: flexion, Abd, IR
- knee: flex or ext
- ankle: DF, Eversion
- toes: ext
Extension:
- hip: ext, Add, ER
- knee: Flex, ext
- ankle: PF, Inv
- toes: flexion
Please list contraindications for e-stim
- Pacemaker
- Hypersensitivity
- Infection
- Pregnancy
- Malignancy
- Cardiac arrythmias
- Not over carotid sinus area
- Musculoskeletal problems
Please list the contraindication for ultrasound
- Acute injury for thermal effects
- Decreased sensation
- Vascular insufficiency
- Thrombophlebitis
- Eyes
- Reproductive organs
- Pregnancy
- Pacemaker
- Malignancy
- Epiphyseal area
- Total jt replacements (metal)
- Infection
Please explain the difference between open chain exercises and closed chain exercises.
Open chain
- movement of distal body segment in space
Closed chain
- movement of distal body segment that remains fixed or in contact with support surface
What are the subcategories of the gait cycle?
initial contact, loading response, midstance, terminal stance, preswing, initial swing, midswing, terminal swing
Please explain the joint position for D1 flexion/extension of the UE
Flexion
- Shoulder: flex, Add, ER
- Scapula: elevation, Abd
- Elbow: flex
- Forearm: supination
- wrist: flex, RD
- fingers: flex, Add
Extension
- Shoulder: Ext, Add, IR
- Scapula: depression, Add
- Elbow: ext
- Forearm: pronation
- wrist: Ext, UD
- fingers: ext, Abd
Please stand up in front of the class and show us where the motor point for the bicep tendon is and why this would be important for electrical stimulation
- negative electrode placement
Explain parameters for US on an acute injury of the hamstring that has swelling and edema.
- 50% duty cycle
- 5cm head
- 1 MHz
- 1.0 intensity
- 8 minutes tx time
For mechanical traction of the cervical spine, what is the max amount of force that should be applied during this treatment.
20 pounds
Explain why someone might present during a gait analysis with a foot drop.
- weak DF
- peripheral Neuropathy
- decreased jt ROM
Please give a functional exercise or movement that relates to D1 flexion/extension of the LE
Flexion
- rolling from supine to sidelying, ascending stairs (swing phase), stepping outside leg into tub or car, passing in soccer, donning/doffing pants and shoes
Extension
- LE stance phase of gait, walking backwards and sideways, ascending stairs (stance phase), stance leg while stepping in or out of tub or car, skating backward in hockey.
what are the parameters for an electrical stimulation treatment where your patient is in the acute phase of healing with intense pain located across the low back.
IFC - 4 pads criss crossed
frequency 80-150pps
tx time 8-15 minutes
normal response: tingling (pins and needles)
pick one person from your group to come up and explain the calculation to determine intensity and treatment time for an ultrasound treatment.
deg C of desired effect / temp increase per minute
What is the definition of Neurotmesis?
the complete transection of a peripheral nerve. produced complete sensory and motor deficits to skin and muscles innervated by that injured nerve.
weak (R) glute med
Patient is s/p R CVA and presents to the inpatient rehab clinic 4 days post stroke with noticeable L UE disfunction. You decide this patient would benefit from PNF. Please demonstrate the proper movements with joint positioning explanation for D1 flexion/extension utilizing Rythmic Initiation.
- D1 flexion = shoulder flexion, Add, ER, forearm supination, wrist RD and flexion, and finger flexion
- D1 extension = Shoulder extension, Abd, IR, forearm pronation, wrist UD and extension and finger extension
- RI = passive, AA, active, resisted
Patient is a 24 year old male who is s/p R bicep tendon repair. You have been seeing this patient for 6 weeks now and are noticing he is lacking strength with elbow flexion. You decide to try electrical stimulation for muscle strengthening. Please explain your parameters and electrode placement.
frequency - 70-85pps
intensity - eliciting a muscle contraction
pulse duration - 300-600 microseconds
on/off time - on: 10-15 seconds / off: 50 seconds-2 minutes
Jake is a 22 y/o male who fell off his bull during a competition onto his L knee 3 days
ago. Upon evaluation, all special tests were negative, but he does have increased edema
at his medial L quad. He is unable to walk and has had to put his bull riding on hold due
to the edema. He is wondering what you are going to do for him to help the swelling
because he wants to get back to riding
Parameters:
- 1 MHz
- intensity 0.5 -2.0
-pulsed, 20-50% duty cycle
- tx time 5-10 min
-normal response -no heat felt
Double Jeopardy: Describe the COM and BOS in quadruped
Wide BOS and Low COM