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O Exam 2

notes resist, aerobic, jt mob, sx, gait, arthritis

TermDefinition
slow twitch (ST) type I, red oxidative, large numerous mitochondria, triglycerides, enzymes for aerobic work, low myosin ATPase & glycolytic activity, lower calcium handling ability, shorter speed, good for endurance activities
fast twitch (FT) type II, white glycolytic, anaerobic, contract at a higher speed than type I fibers, high levels of myosin, ATPase provides energy for speed of contract & tension, low myoglobin content, few mitochondria, 3 subtypes
3 elements of mm performance strength, power & endurance
overload principle resistance applied must be great enough to at least briefly exceed the mm capacity- can be applied to both strength & endurance exercise
reversibility principle within a week or 2 "detraining" begins
progression principle intensity of the program must become progressively greater to continue making gains
signs of fatigue pain/cramping, trembling, movement slows, substitution, jerky movements
general strength training recommendations for elderly physician approval, close supervision initially, monitor vital signs, low resistance, low repetitions initially, progress by increasing reps, then by small amts of resist, avoid high resist to decrease stress on joints, train 2 or 3x/week w/48-hr rest int
neural adaptations-increased motor recruit-skeletal mm adaptations hypertrophy (sarcameres & mm cells get bigger, increase water & vascular content & proteins-actin & myosin-) hyperplasia -increased capillary density, increases in bone, ligament & tendon strength, specific decrease in osteoporosis
DeLorme progressive resistance exercise (PRE) 3 sets of 10 reps (10 rep max), arbitrary increase in resistance each week
Oxford program establishes the individual's 10 RM for the first set, moving to 75% of the 10 RM for the second set, and ending w/50% of the 10 RM for the 3rd set (10 reps ea)
Knight (DAPRE) four sets with variable reps & varying wts
if mm endurance is goal then... sets should increase, reps should increase, and resistance should decrease
exercise parameters- order after warm up, large before small
mm setting exercises low level isometric
stabilization exercises example: wall squat
multiple-angle isometrics otherwise mm would only build strength in one spot
isometric exercise protocol-rule of tens 10-second contractions for 10 repetitions with a 10 sec rest in between, gradually developing tension for 2 sec, maintaining a maximal contraction for 6 sec, then gradually decreasing tension for 2 secs
PRE's-progressive resistive exercise originally termed for Delorne's 1 RM with formula used to increase wts & reps-now a gen term for progression of wt & reps w/exercises
max 02 Consumption clinical measurement of body's ability to efficiently use oxygen during higher intensity activity (a measure of fitness) this imporoves when you exercise regularly
ATP produces energy by both aerobic & anaerobic pathways & is possible to improve the efficiency of both w/exercise
sustained activity, moderate intensity, longer duration more likely to be aerobic
intermittant activity, short duration, high intensity more likely to be anaerobic
phosphagen or ATP-PC anaerobic system used during brief bursts of activity lasting periods of 30 seconds
glycolytic system anaerobic for 30-90 sec bouts of activity that are relatively high intensity
Type I fibers slow twitch-are selectively recruited during low intensity activity
Type II B fibers fast twitch- selectively recruited during activities that involve power (factor of speed & force)
which part of BP increases in response to aerobic exercise? systolic- unsafe if goes over 170
children 6-17 should exercise 60 min of moderate to vigorous daily exercise
adults 18-65 should exercise 30 min of moderate to vigorous exercise 3-5 days weekly
older adults 65 and older 30 min of moderate or 20 min vigorous exercise 3-5 days weekly
pt with coronary dx inpatient phase phase 1- supervised & monitored progressive ambulation
pt with coronary dx outpatient phase phase 2- monitored low level exercises 3x weekly
pt with coronary dx outpatient program phase 3- transition to recreation
what is joint mobilization? passive, skilled, manual therapy, type of PROM/Stretching
manipulation thrust techniques-high velocity at end ROM
mobilization non thrust techniques
effects of joint mob helps move synovial fluid, maintain extensibilty & tensile strength of articular & periarticular tissues, provides sensory input for proprioceptive feedback
osteokinematics refers to physiological way bony surfaces move on each other-include flex, abd, ext & rot. under volitional control. aka cardinal plane motions
arthrokinematics refer to small mvmts at the bony interfaces (joints) and not under volitional control. aka accessory motions and include glide, spin & roll
capsular pattern predictable limitations that occur with capsular tightness
closed packed position the point where joint is highly congruent, ligaments are taut, joint is well stabilized and accessory motions are minimized
knee... loose-25 degree flex, closed packed- ext & lat rot, capsular pattern-loss of both flex & ext
glenohumeral loose-55 degree abd & 30 degree horizontal ADD, closed- ABD & lat rot, capsular pattern-ER, abd & IR limited
subtalar loose-midway of ROM, closed-supination, capsular pattern-loss of inversion/varus motions
convex moving on concave shd & hip
concave moving on convex knee
Grade I jt mob small amplitude oscillation applied at beginning of ROM
Grade II jt mob moderate amplitude oscillation applied from beginning to mid range of available ROM
Oscillations Grade 1 or 2 1-3 a second or 60-180 a minute. applied for 20 to 60 sec only 4 or 5x. treat daily for pn
Grade III large amplitude oscillation at mid to end range
Grade IV small amplitude motion applied at end range
Grade V high velocity small amplitude thrust applied at end range
Grade 3&4 performed 2-3x weekly
grade 5 performed 1x
used to rx pain Grade 1 & 2
treats joint restrictions Grade 3 & 4
thrust-break adhesions Grade5
contra for mobilization extreme caution in early stages after trauma, sx, or immediately after immobilization. jt effusion, severe swelling indicating acute inflammation. absolute contras: osteoporosis, RA, jt hypermobile, neurologic symptoms
precautions for mobilization cancer, total jts, elderly
max protection phase after sx protect incision, fall prevention, modify activity & wt bearing, promote tissue healing, decrease stress on operated tissues, instruct on donning & doffing sling, immobilizers, pn mgmt, pendulum ex, AP to prevent DVT's & edu for emboli, TED hose, 2-3 wks
therapy interventions in max protection phase after sx mm setting, AROM, wound care, wt bearing precautions
mod protection phase after sx progression of activity & promotion of independence. pt often returns to work & may still have some restrictions. expect will come out of immobilizer/brace. progress AROM to stretching & begin resistive ex per protocol. often lasts into 2nd postop month
therapy interventions in mod protection phase after sx progression to cane or dc of AD, dc of isometrics & begin closed chain strengthening, ROM, scar massage & stretching to increase ROM. pt may see PTA only weekly for progression of program
min protection/return to function phase after sx pt should not have restrictions & should be painfree for most part. operated jt should be stable. pt should be returned to 80% of normal activity. goal should be to improve strength & ROM to non-operated side levels. extends into 3rd post op month
therapy interventions in min protection phase after sx high level balance & stability exercises, progress patient to physical fitness level & teach pt stretching & strengthening at max potential. ed pt to prevent overuse.
potential postoperative complications & risk reduction pulmonary complications, DVT, subluxation or dislocation, restricted motion from adhesions & scar tissue formation, failure, displacement or loosening of internal fixation, wound infection
allergic reactions & ADR fairly common and include hives, difficulty breathing, nausea, vomiting, confusion, vertigo, GI bleeding, ulcers
prescription dose of NSAID available by injection Ketorolac
only COX2 inhibitor left on market Celebrex-lower risk of side effects than NSAIDS, fewer bleeding related & stomach related side effects
corticosteroids-powerful antiinflammatory & immunosuppressant medications used for... RA, OA, carpal tunnel, gout, bursitis, lupus- contraindicated for DM
most common infection post-op staph (staph aureus)
resistant microbes- MRSA
common infections that can cause UTI/PNA Klebsiella & Psedomonas
Very resistant hospital acquired infection of GI tract clostridium difficile or C diff- treated with flagyl
common antibiotics penicillins, ampicillins, cefazolin, flagyl, cipro, vancomycin
superficial zone of articular cartilage adjacent to jt space-thin layer of small collagen fibers which lie parallel
intermediate zone of articular cartilage collagen fibers form a coiled interlacing network. note chondrocytes intermeshed
deep zone of articular cartilage thicker collagen fibers that form a tighter meshwork
calicified zone of articular cartilage lies above subchondral bone. collagen fibers are very thick and attach the cartilage to the bone. the tidemark is an irregular line that separates the deep and calcified zone
eburation when the bone has been rubbed smooth
Heberden's nodes at DIPS
Bouchard's nodes at PIPS
pannus hypertrophy with overgrowth of granulation tissue that extends across jt surface, thick & visible on x-ray- releases lysosomal hydrolytic enzymes that erode cartilage, ligaments, tendons & subchondral bone
classic joints affected by RA PIPS & MCP jts of hands, MTP of feet & knees - shd
ulnar drift MCPS drift in ulnar direction
boutonniere PIP flexion, DIP ext
swan neck PIP hyperext, DIP flex
mallet deformity loss of DIP ext
hallux valgus bunion-can be OA or RA or something else-big toe bends in toward other toes
hammer toes hyperext MTPs, flex PIP, ext DIP
claw toes MTP ext with flex of DIP & PIP
stance phase 60%, foot is in contact w/ground, wt acceptance & single limb support
swing phase 40%, foot is off ground, limb advancement, 3 phases (preswing, midswing, terminal swing)
step contact on one foot on ground until contact with the other foot
stride contact with one foot on ground until contact with same foot
gait cycle heel strike to heel strike of same foot-describes what pt is doing
stride length difference between 2 successive heel strikes of the same foot- distance in inches or cm
step length difference heel strike of one foot to heel strike of the other (average 15")
IC initial contact
LR loading response
MSt mid stance
TSt terminal stance
PSw preswing
ISw initial swing
MSw midswing
TSw terminal swing
cadence number of steps per unit time. average is 90-120 per minute
initial contact to loading response dorsiflexors eccentrically, quads eccentrically, hip ext concentrically
loading response to midstance plantarflexors eccentrically, concentric quads, glute contract
midstance to terminal stance plantarflexors concentric, glutes contract
terminal stance to pre-swing concentric hamstring, concentric hip flexors
initial swing to midswing concentric hamstrings, hip flexors concentric
midswing to terminal swing isometric dorsiflexors, momentum, eccentric hamstrings, eccentric gluteals & hamstrings
antalgic gait gait pattern accompanied by pn, observable reduction in motion at painful jt & asymmetry, compensations seen: trunk leaning to or away from painful jt during stance phase
lateral trunk bending observed in patients attempting to minimize jt compression loads & pn during amb. pt leans toward the stance leg of the wk abductors to min the force require to prevent downward mvmt of pelvis. also Trendelenburg gait or waddling
post trunk lean during early stance or early swing phase of gait cycle. pt leans post to move the line of gravity of the trunk behind the hip jt
ant trunk lean stance phase of gait, compensation for quad weakness
excessive ankle plantar flex observed in both the stance & swing. vaulting: during midstance. swing phase, done to avoid tripping due to toe drag
hip circumduction advancing of the swing leg in lat semicircular pattern. compensation for lack of hip flex, knee flex, or ankle dorsiflex
increased knee flex observed during loading response or terminal stance phase. may be due to knee flex contracture, knee pn, knee jt effusion
contralateral pelvis drop excessive downward mvmt of the pelvis of the swing leg. caused by hip abd wkness or neuromm dx. also called Trendelenburg sign
SAID principle Specific Adaptation to Imposed Demands
vasculitis inflamed blood vessels
colitis bleeding from GI tract
splenomegaly big spleen
aoritis inflamed aorta
endocarditis inflammation of heart, lifespan shorted in RA pts due to heart probs
Created by: jessigirrl4