notes resist, aerobic, jt mob, sx, gait, arthritis
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| 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
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| 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
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| 3 elements of mm performance | strength, power & endurance
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| overload principle | resistance applied must be great enough to at least briefly exceed the mm capacity- can be applied to both strength & endurance exercise
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| reversibility principle | within a week or 2 "detraining" begins
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| progression principle | intensity of the program must become progressively greater to continue making gains
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| signs of fatigue | pain/cramping, trembling, movement slows, substitution, jerky movements
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| 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
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| 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
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| DeLorme progressive resistance exercise (PRE) | 3 sets of 10 reps (10 rep max), arbitrary increase in resistance each week
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| 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)
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| Knight (DAPRE) | four sets with variable reps & varying wts
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| if mm endurance is goal then... | sets should increase, reps should increase, and resistance should decrease
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| exercise parameters- order | after warm up, large before small
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| mm setting exercises | low level isometric
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| stabilization exercises | example: wall squat
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| multiple-angle isometrics | otherwise mm would only build strength in one spot
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| 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
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| 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
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| 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
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| ATP | produces energy by both aerobic & anaerobic pathways & is possible to improve the efficiency of both w/exercise
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| sustained activity, moderate intensity, longer duration | more likely to be aerobic
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| intermittant activity, short duration, high intensity | more likely to be anaerobic
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| phosphagen or ATP-PC | anaerobic system used during brief bursts of activity lasting periods of 30 seconds
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| glycolytic system | anaerobic for 30-90 sec bouts of activity that are relatively high intensity
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| Type I fibers | slow twitch-are selectively recruited during low intensity activity
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| Type II B fibers | fast twitch- selectively recruited during activities that involve power (factor of speed & force)
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| which part of BP increases in response to aerobic exercise? | systolic- unsafe if goes over 170
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| children 6-17 should exercise | 60 min of moderate to vigorous daily exercise
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| adults 18-65 should exercise | 30 min of moderate to vigorous exercise 3-5 days weekly
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| older adults 65 and older | 30 min of moderate or 20 min vigorous exercise 3-5 days weekly
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| pt with coronary dx inpatient phase | phase 1- supervised & monitored progressive ambulation
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| pt with coronary dx outpatient phase | phase 2- monitored low level exercises 3x weekly
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| pt with coronary dx outpatient program | phase 3- transition to recreation
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| what is joint mobilization? | passive, skilled, manual therapy, type of PROM/Stretching
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| manipulation | thrust techniques-high velocity at end ROM
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| mobilization | non thrust techniques
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| effects of joint mob | helps move synovial fluid, maintain extensibilty & tensile strength of articular & periarticular tissues, provides sensory input for proprioceptive feedback
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| osteokinematics | refers to physiological way bony surfaces move on each other-include flex, abd, ext & rot. under volitional control. aka cardinal plane motions
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| arthrokinematics | refer to small mvmts at the bony interfaces (joints) and not under volitional control. aka accessory motions and include glide, spin & roll
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| capsular pattern | predictable limitations that occur with capsular tightness
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| closed packed position | the point where joint is highly congruent, ligaments are taut, joint is well stabilized and accessory motions are minimized
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| knee... | loose-25 degree flex, closed packed- ext & lat rot, capsular pattern-loss of both flex & ext
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| glenohumeral | loose-55 degree abd & 30 degree horizontal ADD, closed- ABD & lat rot, capsular pattern-ER, abd & IR limited
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| subtalar | loose-midway of ROM, closed-supination, capsular pattern-loss of inversion/varus motions
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| convex moving on concave | shd & hip
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| concave moving on convex | knee
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| Grade I jt mob | small amplitude oscillation applied at beginning of ROM
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| Grade II jt mob | moderate amplitude oscillation applied from beginning to mid range of available ROM
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| 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
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| Grade III | large amplitude oscillation at mid to end range
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| Grade IV | small amplitude motion applied at end range
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| Grade V | high velocity small amplitude thrust applied at end range
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| Grade 3&4 performed | 2-3x weekly
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| grade 5 performed | 1x
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| used to rx pain | Grade 1 & 2
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| treats joint restrictions | Grade 3 & 4
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| thrust-break adhesions | Grade5
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| 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
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| precautions for mobilization | cancer, total jts, elderly
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| 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
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| therapy interventions in max protection phase after sx | mm setting, AROM, wound care, wt bearing precautions
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| 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
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| 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
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| 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
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| 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.
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| 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
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| allergic reactions & ADR | fairly common and include hives, difficulty breathing, nausea, vomiting, confusion, vertigo, GI bleeding, ulcers
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| prescription dose of NSAID available by injection | Ketorolac
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| only COX2 inhibitor left on market | Celebrex-lower risk of side effects than NSAIDS, fewer bleeding related & stomach related side effects
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| corticosteroids-powerful antiinflammatory & immunosuppressant medications used for... | RA, OA, carpal tunnel, gout, bursitis, lupus- contraindicated for DM
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| most common infection post-op | staph (staph aureus)
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| resistant microbes- | MRSA
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| common infections that can cause UTI/PNA | Klebsiella & Psedomonas
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| Very resistant hospital acquired infection of GI tract | clostridium difficile or C diff- treated with flagyl
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| common antibiotics | penicillins, ampicillins, cefazolin, flagyl, cipro, vancomycin
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| superficial zone of articular cartilage | adjacent to jt space-thin layer of small collagen fibers which lie parallel
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| intermediate zone of articular cartilage | collagen fibers form a coiled interlacing network. note chondrocytes intermeshed
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| deep zone of articular cartilage | thicker collagen fibers that form a tighter meshwork
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| 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
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| eburation | when the bone has been rubbed smooth
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| Heberden's nodes at | DIPS
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| Bouchard's nodes at | PIPS
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| 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
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| classic joints affected by RA | PIPS & MCP jts of hands, MTP of feet & knees - shd
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| ulnar drift | MCPS drift in ulnar direction
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| boutonniere | PIP flexion, DIP ext
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| swan neck | PIP hyperext, DIP flex
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| mallet deformity | loss of DIP ext
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| hallux valgus | bunion-can be OA or RA or something else-big toe bends in toward other toes
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| hammer toes | hyperext MTPs, flex PIP, ext DIP
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| claw toes | MTP ext with flex of DIP & PIP
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| stance phase | 60%, foot is in contact w/ground, wt acceptance & single limb support
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| swing phase | 40%, foot is off ground, limb advancement, 3 phases (preswing, midswing, terminal swing)
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| step | contact on one foot on ground until contact with the other foot
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| stride | contact with one foot on ground until contact with same foot
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| gait cycle | heel strike to heel strike of same foot-describes what pt is doing
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| stride length | difference between 2 successive heel strikes of the same foot- distance in inches or cm
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| step length | difference heel strike of one foot to heel strike of the other (average 15")
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| IC | initial contact
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| LR | loading response
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| MSt | mid stance
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| TSt | terminal stance
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| PSw | preswing
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| ISw | initial swing
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| MSw | midswing
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| TSw | terminal swing
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| cadence | number of steps per unit time. average is 90-120 per minute
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| initial contact to loading response | dorsiflexors eccentrically, quads eccentrically, hip ext concentrically
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| loading response to midstance | plantarflexors eccentrically, concentric quads, glute contract
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| midstance to terminal stance | plantarflexors concentric, glutes contract
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| terminal stance to pre-swing | concentric hamstring, concentric hip flexors
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| initial swing to midswing | concentric hamstrings, hip flexors concentric
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| midswing to terminal swing | isometric dorsiflexors, momentum, eccentric hamstrings, eccentric gluteals & hamstrings
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| 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
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| 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
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| 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
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| ant trunk lean | stance phase of gait, compensation for quad weakness
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| excessive ankle plantar flex | observed in both the stance & swing. vaulting: during midstance. swing phase, done to avoid tripping due to toe drag
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| hip circumduction | advancing of the swing leg in lat semicircular pattern. compensation for lack of hip flex, knee flex, or ankle dorsiflex
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| increased knee flex | observed during loading response or terminal stance phase. may be due to knee flex contracture, knee pn, knee jt effusion
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| 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
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| SAID principle | Specific Adaptation to Imposed Demands
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| vasculitis | inflamed blood vessels
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| colitis | bleeding from GI tract
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| splenomegaly | big spleen
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| aoritis | inflamed aorta
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| endocarditis | inflammation of heart, lifespan shorted in RA pts due to heart probs
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