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Ther. Ex. Final Exam

Q1: Dominant hostile -Stubborn/ argumentative -Fixed positions & sticks to them -Talks a lot, rather than listen, interrupts -Pushy, arrogant, brash, beligerent
Q2: Submissive-hostile -Uninvolved, quiet, withdrawn, sullen -Passive & backs down easily -Talks little & doesn't listen well -Avoids/ ignores issues
Q3: Submissive-warm -Outgoing, friendly, social -Appeases, compromises, glosses over issues -Talks a lot, listens some, unbusinesslike -Meanders, lacks organization, unfocused
Q4: Dominant-warm -Sincere, open, candid, responsive -Explores, listens, summarizes others positions -Open-minded, flexible, understanding -Analytical, task- oriented, non-blaming
Most personalities are: Q3 and Q4
How to observe the whole pt: -Facial grimaces -Compensations -Guarding -Conversations
Examination -Data collection and scales
Evaulation -Processing and applying data
Palpation of skin -Warm -Cold -Turgor -Swelling
Dermatomes -Light vs. Sharp touch -Hypo-, normal, hyper- sensitive
Myotomes -Looking for endurance of max contraction, fatiguing weakness
ROM important note: -Not just an issue of a tight muscle -Tissue integrity: not only or always strength issue/ more endurance as you know it
PROM Indications: -P! -Swelling/ impaired circulation -Muscle guarding -Shortened tissue -Prevent loss of ROM -Limited tissue tolerances/ proliferation
PROM contraindications: -MD orders -Empty end feel/impingement -Bony end feel -Jt. crepitus -Infection/ hematoma -Unstable direction/ jt.
AAROM and AROM won't: -Will not develop pure strength unless very weak/ low level
Toe region -Collagen waves removed -1st tissue stop at end of region -Shorter with age
Elastic region -Elongated but returns to normal
Plastic region -2nd tissue stop -Microscopic failure -Length changes -More velocity dependent
Necking -Weakening -Less force needed for elongation -Failure quickly even with less force
Creep phenomenon -Longer stress= greater strain or viscosity
Warmer tissue = -Less chance of injury and greater lengthening
Viscous -Resistance to flow; thick and sticky
Muscle spindle -Mechanoreceptor that senses speed of strain
Golgi Tendon Organ (GTO) -Mechanoreceptor that senses amount of strain
Tissues limiting ROM -Skin adhesions -Muscle/ tendon -Various types of muscle guarding -Neurological facilitation of muscle from spine -Capsule: hypo/hyper mobility, impaired arthrokin. -Bursa -Cartilage -Neurological- impingement/ neuropathy -Disc lesion -Bone
Stretching Evidence -No beneficial effect on preventing sports injuries
Stretching Precautions -Osteoporosis -Prolonged immobilization due to tissue sensitivity to stretch -Don't stretch a contracting tissue
Stretching Contraindications -Same for all ROM and.... -Non-elastic/ capsular end feel -Tissues shortening provides stability to the jt in place of the normal stability -Tissue shortening allows for increased function due to other limitations
Stretch Evidence: Static stretch -Best results @ 5-30 min. static stretch -No greater benefit between 30-60 min
PNF: Hold/ relax -Stimulate spinal reflexes that create muscle resistance to stretch -Isometric action of tight muscle for 5 sec. -Relax and move into new range
Static vs PNF -Equally effective
Active vs Passive -No significant difference
Muscle Energy Technique -Similar to PNF -Applied to H. Abds vs ERs and control
Active Isolated Stretching Evidence -Static stretching better
Lumbar JM Stretching Evidence -Significantly increased hamstring length vs. stretching or controls
Stretching for less/more rigid muscles -Short duration for less rigid muscle restrictions -Hamstring studies: static significant increase; passive hold lasted 3 min. -Long duration for more rigid muscle restrictions (i.e after immobilization, fxs)
Stretching evidence: Refutes increased mm extensibility due to: -Neuromuscular relaxation with Static/ Ballistic/ PNF -Viscoelastic deformation of mm -Plastic deformation o
Stretching recent theories -Sensory Theory: Increased muscle extensibility due to alteration in perceived sensation/ Uncertain peripheral and/or central phenomenon -Psychological alteration of willingness to tolerate more “stretch
Adaptive shortening -i.e. a muscle contracture or decreased muscle extensibility cannot be determined by ROM alone
Post injury/ sx scar tissue strength -10% at 1 wk -40% at 6 weeks- safe with 2nd tissue stop Rx -70% at 2 months (8-9 weeks) -100% at 1 year
Measuring Strength -Repetition maximum (RM) -Dynamometry- isometric -Cable tensiometry- isometric -Isokinetic machines -Manual muscle testing (MMT)
Resistance -Force that opposes motion
Thera-band -Less resistance than tubing
Resistance exercise indications -Best injury prevention
Resistance exercise precautions -Acute injury -Cardiovascular Dx- Valsalva maneuver -Deconditioned patients -Progressive weakening -Elderly re: positions/parameters -DOMS -Dehydration
Overload principles -Tissue must be challenged to perform at a level greater than to which it is accustomed; guiding principle of exercise prescription
SAID Specific adaptation to imposed demands
Isometric beneficial with: Isotonic
Remodeling phase 2 wks to a month
Repair phase 48 hrs to 10 wks
Dense connective tissue is what type of collagen Type I; resists tension
Ligament/Capsule healing: Tensile strength 50% @ 6mths 80% @ 1 yr 100% in 1 to 3 yrs
Bone Type I collagen; resists tension -1/3 organic 2/3 inorganic
Bone healing Repair: soft boney callus forms ( 1 to 3 wks) Modeling- hard boney callus Remodeling- heals 100% original collagen (3 to 4 mths)
Fracture -Start PT @ 3-8 wks of immobilization
Articular cartilage -Type II collagen; compression; ends of long bones; avasular
OA most common @ what jts Hip and knee -OA heals with type I collagen (tension)
Fibrocartilage Healing: Tensile strength -Improves @ 3-5 wks (40% integrity) even better when dense fibrous tissue fills @ 10-12 wks (70% integrity)
Difference in partial meniscectomy vs Meniscal repair Partial: faster recovery, early ROM, FWB sooner, higher risk of degeneration Repair; longer time line, slow recovery, lower risk of degeneration
Tendon Type I collagen; tension; hypovascular/neural
Tendon ruptures higher forces during fast eccentrics
Tendon healing Tensile strength really improves @ ~3-5 wks (~40% integrity) Even greater tensile strength when dense fibrous tissue fills in @ ~ 10-12 wks (~70% integrity)
Sarcomere functional unit of skeletal mm
Muscle healing ~ 1 wk- central zone of injury filled in with dense fibrous tissue ~ 3 wks- central zone of injury has all but disappeared in most strains but remodeling still occurring
Created by: alovedaytn
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