Ther. Ex. Final Exam
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| Q1: Dominant hostile | -Stubborn/ argumentative
-Fixed positions & sticks to them
-Talks a lot, rather than listen, interrupts
-Pushy, arrogant, brash, beligerent
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| Q2: Submissive-hostile | -Uninvolved, quiet, withdrawn, sullen
-Passive & backs down easily
-Talks little & doesn't listen well
-Avoids/ ignores issues
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| Q3: Submissive-warm | -Outgoing, friendly, social
-Appeases, compromises, glosses over issues
-Talks a lot, listens some, unbusinesslike
-Meanders, lacks organization, unfocused
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| Q4: Dominant-warm | -Sincere, open, candid, responsive
-Explores, listens, summarizes others positions
-Open-minded, flexible, understanding
-Analytical, task- oriented, non-blaming
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| Most personalities are: | Q3 and Q4
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| How to observe the whole pt: | -Facial grimaces
-Compensations
-Guarding
-Conversations
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| Examination | -Data collection and scales
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| Evaulation | -Processing and applying data
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| Palpation of skin | -Warm -Cold -Turgor -Swelling
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| Dermatomes | -Light vs. Sharp touch
-Hypo-, normal, hyper- sensitive
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| Myotomes | -Looking for endurance of max contraction, fatiguing weakness
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| 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
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| PROM Indications: | -P!
-Swelling/ impaired circulation
-Muscle guarding
-Shortened tissue
-Prevent loss of ROM
-Limited tissue tolerances/ proliferation
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| PROM contraindications: | -MD orders
-Empty end feel/impingement
-Bony end feel
-Jt. crepitus
-Infection/ hematoma
-Unstable direction/ jt.
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| AAROM and AROM won't: | -Will not develop pure strength unless very weak/ low level
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| Toe region | -Collagen waves removed
-1st tissue stop at end of region
-Shorter with age
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| Elastic region | -Elongated but returns to normal
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| Plastic region | -2nd tissue stop
-Microscopic failure
-Length changes
-More velocity dependent
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| Necking | -Weakening
-Less force needed for elongation
-Failure quickly even with less force
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| Creep phenomenon | -Longer stress= greater strain or viscosity
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| Warmer tissue = | -Less chance of injury and greater lengthening
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| Viscous | -Resistance to flow; thick and sticky
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| Muscle spindle | -Mechanoreceptor that senses speed of strain
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| Golgi Tendon Organ (GTO) | -Mechanoreceptor that senses amount of strain
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| 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
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| Stretching Evidence | -No beneficial effect on preventing sports injuries
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| Stretching Precautions | -Osteoporosis
-Prolonged immobilization due to tissue sensitivity to stretch
-Don't stretch a contracting tissue
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| 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
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| Stretch Evidence: Static stretch | -Best results @ 5-30 min. static stretch
-No greater benefit between 30-60 min
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| 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
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| Static vs PNF | -Equally effective
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| Active vs Passive | -No significant difference
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| Muscle Energy Technique | -Similar to PNF
-Applied to H. Abds vs ERs and control
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| Active Isolated Stretching Evidence | -Static stretching better
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| Lumbar JM Stretching Evidence | -Significantly increased hamstring length vs. stretching or controls
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| 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)
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| Stretching evidence: Refutes increased mm extensibility due to: | -Neuromuscular relaxation with Static/ Ballistic/ PNF
-Viscoelastic deformation of mm
-Plastic deformation o
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| 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
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| Adaptive shortening | -i.e. a muscle contracture or decreased muscle extensibility cannot be determined by ROM alone
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| 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
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| Measuring Strength | -Repetition maximum (RM)
-Dynamometry- isometric
-Cable tensiometry- isometric
-Isokinetic machines
-Manual muscle testing (MMT)
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| Resistance | -Force that opposes motion
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| Thera-band | -Less resistance than tubing
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| Resistance exercise indications | -Best injury prevention
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| Resistance exercise precautions | -Acute injury
-Cardiovascular Dx- Valsalva maneuver
-Deconditioned patients
-Progressive weakening
-Elderly re: positions/parameters
-DOMS
-Dehydration
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| Overload principles | -Tissue must be challenged to perform at a level greater than to which it is accustomed; guiding principle of exercise prescription
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| SAID | Specific adaptation to imposed demands
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| Isometric beneficial with: | Isotonic
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| Remodeling phase | 2 wks to a month
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| Repair phase | 48 hrs to 10 wks
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| Dense connective tissue is what type of collagen | Type I; resists tension
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| Ligament/Capsule healing: Tensile strength | 50% @ 6mths
80% @ 1 yr
100% in 1 to 3 yrs
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| Bone | Type I collagen; resists tension
-1/3 organic 2/3 inorganic
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| Bone healing | Repair: soft boney callus forms ( 1 to 3 wks)
Modeling- hard boney callus
Remodeling- heals 100% original collagen (3 to 4 mths)
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| Fracture | -Start PT @ 3-8 wks of immobilization
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| Articular cartilage | -Type II collagen; compression; ends of long bones; avasular
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| OA most common @ what jts | Hip and knee
-OA heals with type I collagen (tension)
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| Fibrocartilage Healing: Tensile strength | -Improves @ 3-5 wks (40% integrity) even better when dense fibrous tissue fills @ 10-12 wks (70% integrity)
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| 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
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| Tendon | Type I collagen; tension; hypovascular/neural
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| Tendon ruptures | higher forces during fast eccentrics
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| 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)
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| Sarcomere | functional unit of skeletal mm
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| 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
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