Pta 140 Final Exam

Work on the surface of the water

Ex: Standing shoulder horizontal abduction

Buoyancy helps pt complete the exercise,

Ex: shoulder flexion or extension in vertical position

Pt has to work through bouyancy

Ex: Shoulder adduction while standing

Being supine would change the direction in which the buoyancy was working on the body. For example shoulder abduction and adduction would now be buoyancy supported instead of buoyancy assisted or resisted when the pt was upright. Shoulder extension would now be buoyancy resisted, horizontal abduction would be resisted.

The pressure exerted by the water on a surface.

States that pressure exerted is equal on all surfaces of an object.

Yes

Reduces or limits swelling

Assists in venous return

Induces bradycardia

Centralizes peripheral blood flow (increased CO without increased HR)

Exercises are easier in shallow water due to hydrostatic pressure

(Aquatic Therapy ppt, slide 7)

Friction occurring between molecules of liquid causing resistance to flow; Resistance from viscosity is proportional to the velocity of the movement through the water.

(Aquatic Therapy ppt, slide 8)

It has 2 ways to increase resistance

Increase speed of movement

Increase surface area moving through the water

An increase in turbulence and resistance.

Neck 10% WB

Xiphoid 30% WB

ASIS 50% WB

(AquaticTherapy ppt, slide 5)

•78.8–95 Degrees F is appropriate forexercises and gait training

•91.4 degrees F is more beneficial for pain

•78.8–82.4 for aerobic exercise

Increased muscular relaxation

increased sensory input

decreased pain sensitivity

decreased muscle spasm

increase ease of movement

increase muscular strength and endurance

in cases of excessive weakness

decreased gravitational forces

increased function of respiratory muscles

increased body awareness and balance and proximal trunk stability increased morale and confidence (Aquatic Therapy ppt, slide 21)

Fever

open wounds

contagious rash or infectious disease

hx of uncontrolled seizure

allergies to chlorine

autonomic dysreflexia

unstable angina

severe kidney failure

colostomy

in dwelling catheter

significant cognitive impairments

inability to transfer

uncontrolled bp, decompensated CHF

vital capacity less than 1 liter

danger of hemorrhage or bleeding

(AquaticTherapy ppt, slide 24)

Add equipment to increase drag.

Increase speed of exercise to increase resistance.

Have water move past patient requiring them to work harder to keep position.

It remains relatively unchanged with pool exercise.

(Aquatic Therapy ppt, slide 7 – notes)

Borg scale (Aquatic Therapy ppt, slide 7 - notes)

Make the instrument being used bigger to make it more difficult and smaller to make it easier. (Aquatic Therapy ppt, slide10-11)

Functional Balance

To Determine activity limitations and participation restrictions and to identify tasks that a patient needs to practice (Pg. 272)

Sensory Organization (Pg. 271)

Foam and Dome is also known as Clinical Test of Sensory Integration on Balance Test (CTSIB) (Pg. 272)

• Reduce visual inputs; reduce somatosensory cues(Pg. 271)
  
• To reduce or destabilize the visual inputs,have the patient close the eyes, wear prism glasses, or move the eyes and head together during the balance activity.
  
• To decrease reliance on somatosensory cues, patients can narrow the BOS, stand on foam, or stand on an incline board (Pg. 276)
  

Static Balance Test (Pg. 271)

• Activities to promote static balance include having the patient maintain sitting, half-kneeling, tall kneeling, and standing postures on a firm surface.
• More challenging activities include practice in the tandem and single-leg stance, lunge, and squat positions.
• Progress these activities by working on soft surfaces (foam, sand grass), narrowing the base of support, moving the arms, or closing the eyes.
• Provide resistance via handheld weights or elastic resistance.
• Add a secondary task (catching a ball or mental calculations) to further increase the level of difficulty (Pictures on page 273)

Even surface

- eyes open

- eyes closed

- manual perturbations

- throwing and catching

Uneven Surface

- eyes open

- eyes closed

Double limb

- eyes open

- eyes closed

- manual perturbations

- weight shifting

Single leg

- eyes open

- eyes closed

- postural stresses

By changing the surface type or inclination.

Concret - Carpet - Tile - Gravel

Mini tramp - Foam - Baps board - Rocker board

Stand slightly behind andto the side of the patient with one arm holding or near the gait belt and theother arm on or near the top of the shoulder (on the trunk, not the arm) (Pg.273)

1. Anticipatory control (feedforward) reaching, throwing,catching, kicking, lifting, obstacle course.
2. Reactive (feedback) standing sway, ankle strategy, hipstrategy, stepping strategy, perturbations, working on sway and control(balance and coordination ppt & pg 271)
   

· Pronation – supination

· Heel on shin (supine)

· Finger to nose

· Finger opposition

· Toe tapping

(Balance and coordination ppt)

Static Sitting

Unevensurfaces/perturbations

Yes

Ankle

Hip

Stepping

• Usually used on a firm surface stable surface. For a posterior perturbations it starts with the gastrocs. For an anterior perturbation it starts with the anterior tibiialis.
  
• Muscle activation occurs distal to proximal
  
• Gastrocs - Hamstrings - Paraspinals
  
• Anterior tib - Quads - Abdominals
  

• This is used when the COG is near the limits of stability (definition of limits of stability.
  
• The sway boundaries in which an individual can maintain their balance without changing their BOS).
  
• Forward sway causes the abdominals to contract and then the quads.
• Backward sway causes the para spinals and then the hamstrings.
• So most people use a combination of these strategies.
  

Muscle activation occurs in proximal to distal

Abs - Quads

Paraspinals - Hamstrings

Forward or backward step isused to enlarge the BOS when large forces displaces the COM.

• Muscle weakness

• Gait deficits

• Use of assistive device

• Visual impairment

• OA

• Cognitive impairment

• Past falls

• Medications (4 or more)o

See page 269 Box 8.2

The sway boundaries in which an individual can maintain their balance without changing their BOS.

Intercostals, pecs, levator, SCM, upper trap, suboccipital muscles.

Lower cervical and upper thoracic muscles, scapular retractors, anterior neck musculature, primary neck flexors

(Postural Alignment PPT, slide 23)

One joint hip flexors, external oblique, upper back extensors, neck flexors.

(Postural Alignment PPT, slide 17)

Hamstrings, Upper fibers of IO.

Hip flexors, lumbar extensors

Hamstrings, Abdominals

One joint hip flexors.

(Postural Alignment PPT, slide 19)

Hamstrings, Abdominals

Neck flexors, upper back erector spinae, external oblique, hamstrings.

(PosturalAlignment PPT, slide 21)

Neck extensors, hip flexors, low back

Maintain a normal/ideal lumbar curve

You start at PRONE.

Standing on an unstable surface with no support, reaching, pushing, pulling.

When you start adding resistance and the patient has no exacerbations.

Wide base of support, close to the load as possible, squat to load keeping back straight, grab load keeping it close to your body, lift with legs, keep load close to body (Pg 533, K&C)

Shiftingweight and turning exercise: Have the patient practice shifting weight forward/backward and side-to-side while maintaining the neutral spine position and absorbing the forces with the hip and knee muscles. Practice turning using small steps and rotating at the hips rather than the back. Progress by using weights and having the patient lift, turn, and then place the weight at a new location.

Squatting and reaching exercise: Begin standing. Have the patient reach downward while partially squatting and maintaining neutral spine position with the spinal extensors. Have the patient then stand up and reach overhead while maintaining neutral posture with the trunk flexors. Progress by lifting and reaching with weights while controlling the neutral posture of the spine.

Use both the squatting and reaching exercise and the shifting weight and turning exercise.

Type 1 (10% of max contraction to maintain stability)

The activation of trunk muscles and postural muscles preceding the movement of the extremities. Transverse abdominis and multifidus are always activated with extremity movement.

Spinal extensors activate with shoulder flexion, and trunk flexors activate with hip flexion.

Trunk flexors are activated

Deep muscles: closer to axis of motion, attach to each vertebral segment, and control segmental motion.

Include:transverse abdominis, multifidus, quadratus lumborum, deep rotators, rectuscapitis anterior, rectus capitis lateralis, longus colli.

Superficial: farther fromaxis of motion, cross multiple vertebral segments, produce motion, compressiveloading with strong contractions.

Lumbar: Rectus abdominis, external andinternal obliques, quadratus lumborum, erector spinae, iliopsoas

Cervical:Sternocleidomastoid, scalenes, levator scapulae, upper traps, erector spinae.

• Kinesthetic awareness
  
• Mobility and flexibility
  
• Muscle performance (strength, power,endurance, and stability)
  
• Aerobic training
  
• Functional activities (body mechanics, work habits, sports training)
  

• (minimal in the early/protection phase).
• Low to moderate intensity in the controlled phase.
• High intensity with patient at approaching maximum target HR several times per week.
• Functional Activities: Safe postures and position of pain relief: teach rolling and stability of spine with transitional activities.
• Ergonomic education.
• Strengthening and endurance thatreplicate return to function.
  

Substitution of the extensor digitorum longus and the extensor hallucis longus muscles results also in tow extension. Instruct the patient, therefore, to keep the toes relaxed so that they are not pat of the test movement.

• Hip Abduction test
• Pt Position: (Grade 5,4,3) S/L withtest leg on top. Begin test with hip slightly extended beyond midline. (Grade2,1,0) Supine with legs straight.
• Therapist Position : (Grade 5,4,3) Standing behind pt, one hand is used to stabilize at the hip, other hand applies resistance to the lateral thigh just above the knee for a grade 4 and just above the ankle for a grade 5. (Grade 2,1,0) Standing next to pt on side that limb is being tested. Place hand under heel of moving foot to reduce friction on table.
• Pt Instructions: (Grade 5,4,3) Lift your leg up in the air, hold it, don’t let me push it down. (Grade 2,1,0) Try to bring your leg out to the side towards me.
  

A wider BOS creates an easier exercise and a narrower BOS creates a more difficult exercise.

Yellow - Red - Green - Blue - Black - Silver - Gold

• Pt Position: Supine
• Therapist Position: standing next to pt at approx. waist level, one hand is placed lightly on the abdomen in the epigastric area just below the xyphoid process, resistance is given in downward direction.
• Pt Instructions: Take a deep breath as much as you can, hold it, push against my hand and don’t let me push you down.
• Grade 5 – pt completes full inspiratory expansion and holds against max resistance (range of 100 lbs of resistance)
• Grade 4 – Completes maximalinspiratory expansion but yields against heavy resistance
• Grade 3 – Completes maximalinspiratory expansion but can’t tolerate manual resistance
• Grade 2 – Observable epigastric risewithout completion of full inspiratory expansion
• Grade 1 – Palpable contractiondetected under inner surface of lower ribs, provided that abdominal muscles arerelaxed. Another way to detect minimal epigastric motion is by instructing thepatient to “sniff” with the mouth closed
• Grade 0 – No epigastic rise and nopalpable contraction of the diaphragm occur
  

WF - weak functional

That they have limited range of motion with certain muscles that are weak and need strengthening and those that are tight and need strengthening.

• Decrease blood clots
  
• Decrease SOB
• Decrease risk of pneumonia
• Decrease risk of fx
• Decrease tachycardia
• Decrease dizziness
• Decrease orthostatic hypotension
• Increase strength
• Increase capacity

60-70%

MHR= 220-30=190

HR rest + 60-70% (HRmax-HRrest)

Be specific to what activity you are performing to meet the patient’s goals. Strength training has a similar principle.

• After 2 weeks of stopping activity
• Loss of aerobic improvements in a few months
  

The exercise must stress the cardiovascular and muscular system beyond the training stimulus threshold for adaptation to occur.

• Assess exercise intensity based on the person’s perception of exertion.
• Patients are asked, during exercise, to rate how hard they are exercising on a scale of 6 to 20 points.
• To determine heart rate from the Borg scale, multiply one’s perceived rating (e.g., 13) by a factor of 10 (e.g., 130 bpm).
  

Eccentric

Conccentric

• “Stretching- any therapeutic maneuver designed to increase the extensiblity of soft tissue”
• “Manual, self-stretching, Neuromuscular facilitation and inhibition(PNF), Muscle energy, Joint mobilization, Soft tissue mobilization, Neural tissue mobilization, Massage”
• (found in flexibility & mobility ppt,slide 3 and 4)
  

• “As muscle is stretched, so is the muscle spindle.
• The muscle spindles ends the signal to the spinal cord which activates an impulse along with alpha motor neuron.
• This signal goes back to the muscle fiber and causes the muscle to contract or shorten.
• This is called the stretch reflex or myotactic reflex”(found in flexibility & mobility ppt, slide 9)
  

First time you meet the patient; constant feedback, verbal description, demonstration.

This is where you want blocked practice.

patient is able to self-correct, less frequent feedback, moving towards a HEP.

This is where you want Random practice.

Patient is able to perform independently and multi-task (if they’re able to do this in the clinic you should probably progress them.

True

is an environment you can’t control.

is the patient moving things within themselves.

True

Generally you stabilize proximally, but it depends on the stretch (Self-stretch tends to stabilize distally, Manual stretch tends to stabilize proximally)

Increase the number of sarcomeres

-The elastic limit.

Pg 83 in Kisner & Colby-TherEx

Triceps for Hold-relax and Biceps for Agonist

• Rest, Nonsteroidalanti-inflammatory drugs Steroidal anti-inflammatory drugs
• Electrical stimulation
• Exercise
• Transcutaneous electrical nerve stimulation
• Stretching, Iontophoresis
• Cryotherapy, Calcium antagonists
• EXERCISE is the best and most effective treatment.
• (all found on slide 36 on the Resistance exercise powerpoint; also look at pg. 196 in Kisner & Colby Box 6.12)
  

• All of these are training protocols.
• Delorme is when you start with finding the 10 RM and then apply progressive loading on 3 sets of 10 RM. It combines strength and endurance training tests.
• The Oxford is when you start with finding the 10 RM and then apply regressive loading.
• The DAPRE is when you find the 6 RM, then you do higher reps at lower resistance, then lower reps at high resistance.(slide 39-41, Resistance Exercise ppt.
• Also look at tables presented in these particular slides. Table 6.12 in K&C, Table 6.11 in K&C)