TherEX MIDTERM 1

Therapeutic Exercise

100

The systematic and planned performance of bodily movements, postures or physical activities intended to provide a Pt. with

-Remediation or prevention of Impairment 

-Improve, restore or enhance Physical function

-Prevent or reduce health related risk factors

What is Therapeutic Exercise?

200

The Ability of the neuromuscular system through synergistic muscle actions to hold a proximal or distal body segment in a stationary position or to control a stable base during superimposed movement.

What is stability?

300

interaction of sensory and motor systems to allow muscles to respond to proprioceptive and kinesthetic information

What is Neuromuscular control?

400

5 Potential adaptations in response to applied stress as is it relates to Physical Stress Theory

500

The 3 types of Motor task

What is?

Principles of Treating Soft Tissue

100

The stages of inflammation/repair

What is..

Acute stage (inflammatory reaction) 

Sub acute stage (repair/healing) 

Chronic stage (maturation and remodeling)

200

 A clinical condition described as an abnormal adherence of collagen fibers to surrounding trauma or pathology that prevents motion

What is an adhesion?

300

This syndrome is...

• A state that persists longer than 6 months 

• Pain can’t be linked to a source --- physical, psychological, functional 

• Physical, psychological, and emotional 

What is Chronic pain syndrome?

400

4 Examples of tendinous lesions

What is....

• Tenosynovitis- inflammation of synovial membrane 

• Tendinitis- inflammation of a tendon 

• Tenovaginitis- inflammation with thickening of tendon sheath 

• Tendinosis- degeneration of tendon due to repeated stress  

500

Management and precautions for the 3 stags of healing

Acute state management :

• Educate the patient: Recovery time, how to protect injured body part

• Control pain, edema, spasm: Cold, compression, elevation, retrograde massage (after 48 hrs) massaging towards the heart  Immobilization – try not to move as much. Avoid positions of stress to area. Jt mob technique  

• Maintain soft tissue (ST) and jt. Integrity/mobility: PROM – not too much

• Maintain function of surrounding/associated areas: AAROM, AROM, resisted ROM depending on proximity to affected area. Use assistive devices as needed.

• Precautions:
  Use proper dosage of rest and movement. Too much movement = pain/inflammation

• Contraindications: No stretching to site of inflamed tissue. No resistance exercise to site of inflamed tissues  

• Sub-acute management:
  Impairments:
  Pain at end of available ROM. Decreasing edema and jt. Effusion. Developing ST, muscle jt. Contractures. Contracture- permanent tightening. Muscle weakness from disuse. Decreased function
  
  Patient education:
  Anticipated healing time/importance of following guidelines Teach HEP and modify as needed.
  
  Promote healing of injured tissue: Monitor tissue response to exercise. Decrease intensity if inflammation occurs.
  
  Restore mobility (ST, jt. Muscle): Progress from PROM-AAROM-AROM. Increase scar/ST mobility/ related areas
  
  Develop neuromuscular control/ endurance/ strength: Multiple angle isometrics. Initiate AROM and protected w/b and stabilization exercises. As healing/ROM improves... progress to isotonic ex. W/emphasis on form
  Maintain integrity/function of associated areas 

• Precautions: Too much motion/activity = resting pain, fatigue, spasm, weakness. Pain should not last longer than few hours after a new activity  
  Chronic stage management (return to function) 
  Impairments:
  ST/jt. Contractures that limit ROM. Muscle weakness, poor endurance, and neuromuscular control. Decreased function in injured part. Loss of normal function in an expected activity  
  Patient education:
  Safe progression of exercise and stretching. Monitor understanding and compliance. Teach ways to avoid re injury. Teach body mechanics/ergonomics.
  Increase ST/ jt./ muscle mobility:  
  Jt. Mobilizations, x-friction, stretching. x-friction --- using middle finger on top of index finger on a jt  
  Improve neuromuscular control, strength, endurance. Progression: Submax to max resistance.  Concentric, eccentric, w/b and non w/b ex. Single plane to multiplane. Shoulder flexion to pnf d2 flexion. Simple to complex motions simulating functional activities. Controlled proximal stability. Safe biomechanics. Progress speed movement  
  
  Improve cardiovascular endurance   
  
  Precautions: No inflammation. No pain lasting longer than couple hrs. Jt. Swelling, pain lasting > 4 hrs, taking meds = doing too much – back off!
  
  

ROM

100

1.This is what the shortest muscle length is described as...

2.This is what the longest muscle length is described as...

What is...

• Shortest muscle length- active insufficiency 

• Longest muscle length- passive insufficiency 

200

Principles and procedures for applying ROM

List at least 4....

300

This is what continuous passive motion is and its benefits...

Continuous Passive Motion (CPM)

• Provided by a mechanical device that moves a joint slowly and continuously through a controlled range of motion.

• Benefits: prevent adhesions, stimulate healing soft tissues, increase synovial fluid lubrication, prevent effects of immobilization, provides quicker return of ROM, decreases post-op pain

400

1. WHEN APPLYING PROM:

______  is external, provided by the PTA.

No active ______ or ______ is given by the patients muscles crossing the joint. 

Motion is carried out within the ______ free ROM.

2. WHEN APPLYING AROM:

Demonstrate to the pt. the desired ______ using ______. keep your hands in position to guide or assist.

______ is given only as needed to maintain a smooth motion or when effect or gravity has the greatest torque (moment arm).

Preform w/in pt. ______ ROM.

1. What is Force, Resistance, Assistance, Pain?

2. What is Motion, PROM, Assistance, Available?

500

Indications, contraindications, and goals for the PROM AND AROM.

PROM: 

• Indications:

  • acute inflamed tissue (after surgery usually lasts 2-6 days)

  • When a patient is unable to or not supposed to actively move a segment of the body

• Goals:

  • Decrease the effects of immobilization

  • Maintain joint and connective tissue mobility

  • Minimize contractions

  • Maintain elasticity of muscles

  • Assist circulation and vascular dynamics

  • Increase synovial movement = nourish joint

  • Decrease pain

  • Help maintain patients awareness of movement

• Contraindications:

  • When motion is disruptive to the healing process

  • Signs of pain of inflammation

  • When patient response or the condition is life threatening

  • After MIs, CAB surgery or percutaneous transluminal coronary angioplasty

AROM: 

• Indications:

  • When a patient can contract the muscles actively and move a segment with or without assistance

  • Post immobilization of a segment to the above and below areas to maintain normalcy and to prepare for activities (such as crutch walking)

  • Used as part of aerobic conditioning

• Goals:

  • Maintain physiological elasticity and contractility of participating muscles

  • Provide sensory feedback from contracting muscles

  • Provide a stimulus for bone and joint tissue integrity

  • Increase circulation

  • Develop coordination and motor skills for functional activities

• Contraindications:

  • When motion is disruptive to the healing process

  • Signs of pain of inflammation

  • When patient response or the condition is life threatening

  • After MIs, CAB surgery or percutaneous transluminal coronary angioplasty

?

JointMobilization

100

A general term used to describe any therapeutic maneuver designed to increase extensibility of soft tissue and subsequently improve flexibility/ROM be elongating (lengthening) structures that have adaptively shortened and become hypomobile over time

What is stretching?

200

The difference between a Myostatic and Pseudomyostatic contracture.    

• Myostatic- musculotendinous tissue shortened without muscle pathology present. Stretching techniques used to transfer 

• Ex: hip flexion contracture after THA 

• Pseudomyostatic- caused by spasticity or rigidity associated with CNS lesions. Inhibition techniques result in full excursion of the muscle 

• Ex: stroke  

• Inhibition techniques: getting bicep to release for an elbow flexion contracture  

• Autogenic inhibition 

300

The duration of a stretch should be a  minimum of ______  and no longer than a ______ .

What is 30 seconds, 1.5 minutes? 

400

this type of stretching is defined as 

• Overall function of a patient may be improved by applying stretching selectively to some muscles or joints but allowing a limitation to develop in other muscles or joints

• Give an example 

What is selective stretching?

Stability of the trunk in SC patients is necessary for independent sitting

• Lack trunk control, stretch hamstrings and allow moderate hypo-mobility to develop in the extensors of the low back

• Allows patient to lean into shortened positions and will have stability in long sitting

500

 4 types of PNF stretches and how they work

PNF (proprioceptive neuromuscular facilitation: integrates active muscle contraction into stretching; only contractile elements will be relaxes

• Hold-relax

  • GTO stimulation - autogenic inhibition

  • Pre-stretch, end range, isometric contraction for 10 seconds

• Contract-relax

  • HR & CR used synonymously

  • Contract-relax occurs during the patterns in classic PNF

  • Makes passive elongation of muscle more comfortable

• Agonist contraction

  • Prime mover (agonist) concentrically contracts opposite the range limiting muscle (antagonist)

  • Creates “reciprocal inhibition” of the antagonist

• Hold relax with agonist contraction

  • Variation of the hold-relax technique

  • Pre-stretch isometric contraction of the range-limiting muscle in a lengthened position followed by a concentric contraction of the muscle 

Resistance Exercise for Impaired Muscle Performance

100

A type of resistance exercise defined as:

• Resistance is provided by clinician  

• Sometimes pts can be taught to do this themselves 

• Useful in early stages of rehab and when jt ROM is needs to be restricted  

• No way to measure how much weight/resistance you are doing on the pt  

What is Manual Resistance Exercise (MRE)?

200

"Don't let me move you" is a verbal cue given it this type of MRE exercise.

What is Isometric?

300

The difference between Dynamic (concentric and eccentric) and Dynamic (constant and variable resistance) 

Dynamic (concentric and eccentric):

• Dynamic contraction = jt mvmt 

• Concentric = shortening muscle, accelerate body  

• Produces less force than eccentric max contractions  

• Eccentric = lengthening muscle, decelerate body  

• This makes them very functional  

• Produces more force than max concentric contractions 

• Greater incident of delayed onset muscle soreness (DOMS)  

Dynamic (constant and variable resistance):

• When a limb moves through a ROM against a constant external load (dynamic ex against constant external load dynamic constant external resistance (DCER) 

• Handheld or cuff wts, wt machines, pulley system

  • Specially designed equipment imposes varying levels of resistance to the contracting muscles to load the ms more effectively at multiple pts in the ROM (cybex) 

  • Ex: supine hamstring machine  

400

Guidelines for resistance ex for healthy adults 50-60 years old 

Name at least 5...

• Warm up followed by stretching first 

• Perform dynamic ex through full ROM and target the major ms groups (8-10) 

• Balance pulling ex with pushing exercises  

• Include both concentric and eccentric 

• Moderate intensity 8-12 reps, 2-4 sets, 2-3 min rest between sets 

• Slow to moderate speeds of mvmt 

• Exercise should not interfere with normal breathing  

• Cool down 

500

Elicits a phasic muscle contraction to initiate a given diagonal mvmt pattern

What is a stretch reflex? 

Aerobic Endurance

100

Increased level of oxidative enzymes in the muscle

Increased mitochondrial density and size

Increased muscle fiber capillary supply

Are all a result from improving this....

What is Endurance?

200

A higher value result from this test indicates a better cardiovascular fitness and endurance; gives insight to your aerobic capacity; and is useful for designing endurance based exercise programs

What is a Maximum VO2 Test?

300

220 - age = MHR

220 - 65 = 155 MHR

To determine what her heart rate would be to train at a specific intensity you have to first calculate their heart rate reserve(HRR).

MHR - RHR = HRR

155 - 73 = 82

Then to find her 80% training heart rate 

RHR + (HRR x %intensity) = THR (training heart rate)    

73 + (82 x .8) = 138.6

So she would need to maintain a heart rate of 138.6  to train at 80% intensity 

400

True or False...

1.Aerobic exercise will Increased cardiac output, decrease systolic blood pressure, enhanced blood flow to muscle, and increased blood volume

2.Resting HR is influenced by age 

1.FALSE

Everything is correct except that Aerobic exercise will increase systolic blood pressure not decrease it!

2. ALSO FALSE! 

Resting HR is not influenced by age!!!

500

This metabolic system our body uses to create energy..  

• Breaks down glucose stored in muscles for energy

• Requires no oxygen 

•  Is used for moderate to intense activities lasting 30-90 seconds

What is Anaerobic-glycolytic?

body’s backup energy system when you need quick energy for moderate to intense activities lasting 30-90 seconds

• Breaks down glucose stored in muscles for energy

• Anaerobic - no oxygen required

• Lactic acid produced - build up causes “burning” sensation in muscles 

• max capacity and power is moderate

• Medium length bursts of high effort (running fast for a minute or HIIT workout (can’t last long because lactic acid build up will fatigue muscles) 

Strength and Conditioning Essentials

100

Much of the evidence of improved strength in the first few weeks of training is attributable to this...

What is Neural adaptations?

200

You should use Near max/max loading what your goal is to.....

...to build strength ,power, and or hypertrophy!

300

The amount of resistance imposed on the contracting muscle during each repetition of an exercise

What is intensity?

400

This type of training uses...

• Moderate loads, high volume, short to moderate rest periods 

• Load = 67-85%; reps 6-12; sets 3-6; rest 30 sec-1.5 mins  

What is Hypertrophy training? 

500

This is how proper alignment of an exercise is determined...

What is... determined by the direction of fibers and the line of pull of the muscle to be strengthened?