Term
| During therapeutic exercise, carefully graded (gradual successive) stresses and forces are applied in the following manner |
|
Definition
controlled = control with alignment, stability, & assistance
progressive = increase resistance, increase reps, go a longer distance, change position
appropriately applied = correct exercise or activity for the diagnosis and point in the recovery |
|
|
Term
| If normal stresses are absent |
|
Definition
| body may degenerate, deform, or become prone to injury |
|
|
Term
| With abnormal or repetitive stresses |
|
Definition
| get deformity, pain, and dysfunction |
|
|
Term
| Effectiveness of exercise depends on |
|
Definition
| the patient’s active involvement and on patient education |
|
|
Term
| a variety of cues/techniques to execute & progress the exercise and to educate and involve the patient |
|
Definition
Verbal – explain, question, discuss
Visual – demonstrate, use pictures & models
Tactile – guide, control, correct, stabilize, assist |
|
|
Term
|
Definition
| ability to perform physical work |
|
|
Term
|
Definition
1. Cardiorespiratory functioning & endurance 2. Muscle strength & endurance
3. Musculoskeletal flexibility |
|
|
Term
|
Definition
| ability work for prolonged periods |
|
|
Term
| What is fitness level based on? |
|
Definition
| energy expenditure & measured by oxygen consumption |
|
|
Term
|
Definition
| body’s capacity to use oxygen |
|
|
Term
| How is VO2 Max expressed? |
|
Definition
Relation to body weight
Ml of O2/kg of body weight/min |
|
|
Term
True/False
Increased rate or intensity of exercise results in decreased oxygen consumption |
|
Definition
False
results in increased oxygen consumption |
|
|
Term
| If the heart cannot meet its own need |
|
Definition
|
|
Term
| Other ways to express Intensity of exercise |
|
Definition
Kilocalorie
MET
Heart rate
Borg scale/ rate of perceived exertion |
|
|
Term
|
Definition
metabolic equivalent = O2 consumed per kilogram of body weight per minute
1 MET = 3.5 mL/kg/min |
|
|
Term
| How is heart rate related to oxygen consumption? |
|
Definition
|
|
Term
|
Definition
| Exercise HR = HRrest + 60-70% (HRmax – HRrest) |
|
|
Term
| At what HR does conditioning occur? |
|
Definition
60-90% max HR
or
50-85% VO2 max |
|
|
Term
| BORG’s Rate of Perceived Exertion |
|
Definition
Allows the patient to judge effort (increased heart rate, increased respiration or breathing rate, increased sweating, and muscle fatigue)
Patient must be educated about the scale and how to use it
Original scale correlated to heart rate: 12-14 considered moderate exertion
Revised scale 0-10 |
|
|
Term
| Testing Cardiovascular Fitness in an individual at risk |
|
Definition
Carefully monitored stress testing
“symptom limited” = when a test must be stopped because a sign or symptom is noted, the heart rate at that point becomes the maximum heart rate |
|
|
Term
|
Definition
Losing the ability to perform work occurring with:
sedentary life style
increasing age
bed rest
extended illness |
|
|
Term
| Effects of Deconditioning |
|
Definition
Decreased muscle strength
Decreased muscle mass
Decreased bone mineral density
Decreased cardiovascular function
Decreased exercise tolerance
Decreased heart volume
Decreased orthostatic tolerance
Decreased total blood volume
Decreased plasma volume |
|
|
Term
|
Definition
| Exercise load must be above threshold (a stress) to elicit a training response and once adaptation has occurred, the load must be increased to see an additional improvement |
|
|
Term
|
Definition
| There is little overlap in training effects among various kinds of aerobic exercise. |
|
|
Term
|
Definition
Many factors involved here
In general, the lower the intensity of exercise, the longer the duration needed and vice versa.
20-30 minutes at 70% maximum HR optimal
However, for a very deconditioned individual, 5 minutes three times per day may have a positive effect. |
|
|
Term
|
Definition
Optimal is 3-4 times per week
At lower intensities, more frequent exercise is beneficial
However, a very deconditioned individual may benefit from as little a two times per week |
|
|
Term
| Do patients with coronary disease complete more or less work with arm exercises than with the leg before symptoms occur |
|
Definition
|
|
Term
|
Definition
benefits of exercise training are transient and reversible
Detraining occurs in as little as 2 weeks |
|
|
Term
| The frequency & duration of exercise required to maintain a level of fitness is more or less than that required to improve it |
|
Definition
|
|
Term
Long-Term Physiological Changes That Occur with Aerobic Training
Changes at Rest
Cardiovascular |
|
Definition
Decreased resting pulse
Decreased blood pressure
Increased blood volume & hemoglobin |
|
|
Term
Long-Term Physiological Changes That Occur with Aerobic Training
Changes at Rest
Respiratory |
|
Definition
Increased lung volume
Increased diffusion capacity |
|
|
Term
Long-Term Physiological Changes That Occur with Aerobic Training
Changes at rest
Metabolic |
|
Definition
Muscle hypertrophy and increased capillary density
Increased number & size of mitochondria which increases the capacity to generate ATP aerobically |
|
|
Term
Long-Term Physiological Changes That Occur with Aerobic Training
Changes at rest
other system changes |
|
Definition
Decreased body fat
Increased acclimatization to heat
Increased strength of bones, ligaments, & tendons |
|
|
Term
Changes Noted During Exercise
Cardiovascular |
|
Definition
Decreased pulse rate
Increased cardiac output
Increased extraction of oxygen by working muscles
Increased VO2max resulting in greater work capacity |
|
|
Term
Changes Noted During Exercise
Respiratory |
|
Definition
Larger diffusion capacities
Increased ventilatory efficiency |
|
|
Term
Changes Noted During Exercise
Metabolic |
|
Definition
| Increased capacity to mobilize & oxidize fat |
|
|
Term
| The exercise program consists of? |
|
Definition
warm up
aerobic exercise period
cool down |
|
|
Term
|
Definition
10 minute period of total body movement including stretching
Should be gradual and sufficient to increase muscle and core temperature without causing fatigue
Should attain a heart rate within 20 bpm of target heart rate |
|
|
Term
|
Definition
Increases muscle tissue temperature
increases rate of nerve conduction
facilitates hemoglobin extraction.
Dilates capillaries necessary for oxygen delivery
Increases venous return
Increases muscle flexibility
Adapts sensitivity of neural respiratory center |
|
|
Term
|
Definition
Must be within person’s tolerance
Must be above the threshold level – must overload the system
Must be below the level that evokes clinical symptoms
Exercise should be submaximal, rhythmic, repetitive, dynamic involvement of large muscle groups |
|
|
Term
|
Definition
| 5-10 minutes of total body exercise |
|
|
Term
|
Definition
Prevent pooling of blood by maintaining venous return (muscle pumping)
Prevent fainting by increasing blood return while cardiac output & venous return are gradually decreasing
Enhance the oxidation of metabolic waste and replacement of energy stores |
|
|
Term
|
Definition
Failure of systolic pressure to increase as exercise continues
Systolic pressure of greater than 220 mm Hg (K&C)
Diastolic pressure greater than 120 mm Hg (K&C)
A decrease in systolic pressure of 10-15 mm Hg (O’Sullivan)
Persistent dyspnea |
|
|
Term
|
Definition
Dizziness or confusion
Pain
Severe leg claudication
Excessive fatigue
Pallor, cold sweat
Ataxia
Pulmonary rales
Significant changes in cardiac rhythm (changes noted on EKG) |
|
|
Term
| What are compression pumps? |
|
Definition
| Pneumatic units that apply external pressure to a body part through a sleeve that can be inflated |
|
|
Term
| Pressure in compression pumps |
|
Definition
Multiple compartments inflate from distal to proximal
Sequential
Intermittent
Repetitive
Graded |
|
|
Term
| Indications for Compression |
|
Definition
Venous insufficiency
Venous ulcers
Traumatic edema from localized inflammatory response
Postsurgical edema
Amputations
Prevent Thrombophlebitis
Lymphedema |
|
|
Term
| Type of compression for Venous insufficiency |
|
Definition
Bandages
Pneumatic Pump
Garments |
|
|
Term
| Type of compression for Venous ulcers |
|
Definition
Bandages
Pnuematic pump
Garments |
|
|
Term
| Type of compression for traumatic edema |
|
Definition
|
|
Term
| Type of compression for Postsurgical edema |
|
Definition
|
|
Term
| Types of compression for amputations |
|
Definition
bandages
Pneumatic Pump
Garments |
|
|
Term
| types of compression for prevention of thrombophlebitis |
|
Definition
|
|
Term
| Types of compression for lymphedema |
|
Definition
Bandages
Pneumatic pump
garments |
|
|
Term
| Contraindications for compression |
|
Definition
Ankle/Brachial Index < or = 0.8
Arterial Wounds
Untreated cardiac edema
renal edema
acute infections
acute DVT
edema without diagnosis |
|
|
Term
| Precaustions for compression |
|
Definition
ABI 0.5-0.8
cellulitis post antibiotic treatment
diabetes
paralysis
malignancy
sensory deficits
AMS
Inability to comply with home instructions
sensitivity to compression products
gential edema |
|
|
Term
| Intensity for compression |
|
Definition
Venous disease – max pressure to tolerance without exceeding diastolic blood pressure; not to exceed 60 mmHg
Lymphatic disease – same as above but not to exceed 45 mmHg (some say 40-60 mmHg) |
|
|
Term
| Time and frequency of compression |
|
Definition
Venous disease – 2-4 hours; 1-2 times daily
Lymphatic disease – 1-2 hours; 5-7 times per week |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| initiation of ventricular repolarization |
|
|
Term
| Coronary Artery Disease (CAD) |
|
Definition
an acute or chronic disability resulting from a reduction ( or arrest) of blood supply to the myocardium with associated coronary arterial disease
The most prevalent type of heart disease
Atherosclerosis most common cause |
|
|
Term
| Underlying conditions with Cardiovascular Disease |
|
Definition
Atherosclerosis
Altered myocardial muscle mechanics
Valvular dysfunctions
Arrhythmias
Hypertension (HTN) |
|
|
Term
|
Definition
| hardening of the arteries due to accumulation of fatty deposits/ lipids |
|
|
Term
| Altered myocardial muscle mechanics |
|
Definition
| stiffening/ laxity in myocardial tissue preventing cardiac efficiency |
|
|
Term
|
Definition
| malfunction or non-functioning heart valves |
|
|
Term
|
Definition
|
|
Term
|
Definition
volume of blood ejected from the left ventricle per minute
CO= HR x Stroke Volume ( SV) |
|
|
Term
|
Definition
| volume of blood ejected from the ventricle with each beat |
|
|
Term
|
Definition
Preload
Contractility
Afterload |
|
|
Term
|
Definition
| amt of blood in ventricle at end of diastole, (LVEDV) Left ventricular end diastolic volume. |
|
|
Term
|
Definition
| ability of ventricle to contract |
|
|
Term
|
Definition
| force the LV must generate to push past aortic pressure to open aortic valve |
|
|
Term
|
Definition
| = % of volume of blood ejected from the ventricle at the end of contraction |
|
|
Term
| What is the best indicator of cardiac function |
|
Definition
|
|
Term
| Peripheral Vascular Resistance (PVR) |
|
Definition
| Resistance to the flow of blood that has to overcome to push blood through the circulatory system. |
|
|
Term
| Effective application of exercise depends on |
|
Definition
the structure involved & severity of injury
type of surgical procedure, if applicable
philosophy of surgeon
patient related factors (includes other medical problems the patient may have)
STAGE OF RECOVERY |
|
|
Term
Acute stage of healing (Inflammatory stage)
Max Protection |
|
Definition
Valsular changes
exudattion of cells and chemical
clot formation
phagocytosis, neutralization of irritants
Early fibroblastic activity
clinical signs of inflammation
pain before tissue resistance |
|
|
Term
Subacute stage (repair and healing)
Moderate Protection |
|
Definition
removal of noxious stimulis
growth of capillary beds into area
collagen formation
granulation tissue
very fragile, easily injured tissue
decreasing inflammation
pain synchronous with tissue resistance |
|
|
Term
Chronic Stage (Maturation and Remodeling)
Minimum Protection |
|
Definition
maturation of connective tissue
contracture of scar tissue
remodeling scar
collagen aligns to stress
absence of inflammation
pain after tissue resistance |
|
|
Term
|
Definition
| prolonged inflammation; also overuse syndrome |
|
|
Term
|
Definition
| pain persisting > 6 months, with no links to inflammation or irritation |
|
|
Term
| Long term goal in treatment in tissue healing |
|
Definition
| the formation of a strong, mobile scar that allows complete and painless restoration of function. |
|
|
Term
| remodeling of maturing collagen to occur in response to the stresses placed on it requires |
|
Definition
proper balance between
Rest or protection and Movement |
|
|
Term
Too much immobilization results in
(tissue healing) |
|
Definition
Adhesions
Weakened connective tissue
Changes in articular cartilage |
|
|
Term
Too much movement results in
(Tissue healing) |
|
Definition
Increased pain
Increased inflammation
Injury to new tissue
Delayed, non, or mal union
Increased potential for re-injury & chronic problems |
|
|
Term
How do you know if you have had the patient do too much?
Acute Stage – Maximum Protection |
|
Definition
Increased inflammation
Increased pain |
|
|
Term
How do you know if you have had the patient do too much?
Subacute Stage, Controlled Motion – Moderate Protection |
|
Definition
Discomfort lasting greater than a couple of hours
Pain with rest
Undue fatigue occurring after the exercise has ended
Increased weakness occurring after the exercise has ended
Muscle spasm occurring after the exercise has ended |
|
|
Term
How do you know if you have had the patient do too much?
Chronic Stage, Return to Function – Minimum Protection |
|
Definition
Inflammation
Pain lasting longer than 4 hours
Decrease in strength
Fatigue that occurs more easily |
|
|
Term
| Potential Postoperative Complications |
|
Definition
Increased risk of pulmonary complications
Local or systemic infection
Deep vein thrombosis or pulmonary embolism
Delayed wound healing
Muscle function deficits
Failure, loosening, or displacement of internal fixation devices or joint implants
Delayed union of bone
Rupture of incompletely healed soft tissue
Subluxation or dislocation of joint surfaces or implants
Nerve entrapment from scar tissue
Adhesions and scarring
Loosening of joint implants |
|
|
Term
|
Definition
| mechanical process to move air in & out of the lungs |
|
|
Term
|
Definition
| exchange of gases from air to blood to tissues |
|
|
Term
|
Definition
| “pump handle” : upper ribs & sternum move forward and upward; thoracic spine moves toward extension |
|
|
Term
|
Definition
| “bucket handle”: elevation and outward turning of the mid-shaft of the ribs |
|
|
Term
|
Definition
| “piston” action: central tendon of the diaphragm descends during contraction of the diaphragm |
|
|
Term
| Thorax changes in three planes during ventilation |
|
Definition
AP diameter
Transverse diameter
Vertical diameter |
|
|
Term
| Muscles of Ventilation Quiet breathing/relaxed inspiration |
|
Definition
| Diaphragm contracts & moves downward (actually moves in three planes, not just downward) This movement increases the capacity of the thorax Results in decreased pressure (negative pressure) in the thoracic cavity. The intercostals stabilize the ribcage to keep the chest wall from being sucked inward towards the negative pressure in the thoracic cavity |
|
|
Term
Muscles of Ventilation
Quiet breathing/relaxed expiration |
|
Definition
Only the relaxation of the diaphragm involved
Smooth letting go of the diaphragm; lungs recoil |
|
|
Term
Muscles of Ventilation
Forced, prolonged, deep, or labored inspiration |
|
Definition
| Activation of accessory muscles |
|
|
Term
Muscles of Ventilation
Controlled, forced, or prolonged expiration |
|
Definition
| Activation of muscles, particularly the abdominal muscles, to force out the air |
|
|
Term
|
Definition
| how easily the lungs inflate; to expand by pressure from within (to distend) |
|
|
Term
|
Definition
| tendency to return to original size after distension |
|
|
Term
|
Definition
hindrance to air flow
1. Branching of the airways
2. Size of the lumen – changed by muscle contraction, edema, or accumulation of mucus
3. Elasticity of the lung |
|
|
Term
|
Definition
effort required to inflate the lungs
Requires movement of the lungs and chest wall
Requires overcoming tissue and airway resistance
Requires muscle function |
|
|
Term
| total lung capacity (TLC) |
|
Definition
| amount of air in lungs after max inhalation |
|
|
Term
|
Definition
| max inspiration followed by max exhalation; total volume of air under volitional control |
|
|
Term
|
Definition
| amount of air left after max exhalation |
|
|
Term
|
Definition
| air exchanged with relaxed inhalation then relaxed exhalation |
|
|
Term
| inspiratory reserve volume (IRV) |
|
Definition
| amount of air able to inhale after a relaxed inhalation |
|
|
Term
| expiratory reserve volume (ERV) |
|
Definition
| amount of air able to exhale after a relaxed exhalation |
|
|
Term
| functional residual capacity (FRC) |
|
Definition
| amount of air left in lungs after a relaxed exhalation |
|
|
Term
| inspiratory capacity (IC) |
|
Definition
| max amount of air able to be breathed in after a relaxed exhalation |
|
|
Term
| Indications for suctioning |
|
Definition
Accumulation of secretions
Obstruction of airways by secretions or edema
Decreased cough effectiveness
Inability to swallow
Mechanical ventilation that interferes with the normal cough mechanism |
|
|
Term
|
Definition
|
|
Term
|
Definition
In-line (closed system)
Sterile – direct (open system) |
|
|
Term
| Complications of suctioning |
|
Definition
Hypoxemia: catheter inserted in airway and vacuum applied sucks out oxygen
Aryhthmias: resulting from hypoxemia or vagal stimulation from irritation of the trachea
Hypotension: resulting from bradycardia from vagal stimulation or prolonged coughing during suctioning
Lung collapse: insertion of a catheter that is too large for the airway opening
Mucosal damage from catheter trauma – Even with careful technique, damage can occur |
|
|
Term
| Acute Arterial Dysfunction |
|
Definition
Arterial embolus, thrombus, or trauma
Symptoms: sudden onset; throbbing pain with no relief; pallor; lack of pulses
Medical Emergency
Exercise, heat, and pressure garments contraindicated |
|
|
Term
| PT Management Acute Arterial Dysfunction |
|
Definition
Positioning
Head of bed slightly raised to increase distal blood flow
Minimize pressure on skin
Protect limb
Periodic repositioning |
|
|
Term
Chronic Arterial Dysfunction
Arteriosclerosis obliterans: most common form |
|
Definition
Gradual formation of plaque that diminishes the size of the lumen thus impeding blood flow
Symptoms: earliest is intermittent claudication associated with walking and progressing to pain at rest; diminished or absent pedal pulses; skin color & temperature changes; eventually, trophic changes
Late stages: tissue necrosis & ulcerations |
|
|
Term
| PT Management Chronic Arterial Dysfunction |
|
Definition
Rest & sleep with legs in a dependent but supported position: over edge of bed, head higher than legs in bed or when sitting
Vasodilation with iontophoresis or reflex heating (e.g. contrast bath)
Wound management for ischemic ulcers
Regular, graded aerobic exercise |
|
|
Term
| Contraindications for Graded Exercise |
|
Definition
1. If leg pain increases rather than decreases over time.
2. If there is pain at rest.
3. Foot ulcerations or wound infections – weight bearing exercise |
|
|
Term
| Thromboangitis obliterans (Buerger’s disease) |
|
Definition
Cessation of smoking often arrests the disease
Buerger-Allen exercises: three-stage exercise program originally designed to promote collateral circulation – There is little evidence that these exercises improve blood flow. |
|
|
Term
| Raynaud’s (vasospastic disease) |
|
Definition
Raynaud’s disease = idiopathic; primary disorder
Raynaud’s phenomenon = secondary to another disease such as connective tissue disorders, trauma; occlusive arterial disorders |
|
|
Term
|
Definition
| inflammation of vein(s) secondary to occlusion with a thrombus |
|
|
Term
| Is DVT a medical emergency |
|
Definition
|
|
Term
|
Definition
Fracture or postoperative immobilization
Prolonged bed rest
Trauma to venous vessels
Advanced age
Obesity
Sedentary lifestyle
Congestive heart failure
Malignancy
Use of oral contraceptives
Pregnancy |
|
|
Term
|
Definition
Possible consequence of DVT
Hallmark signs and symptoms
Sudden dyspnea
Tachypnea
Lateral chest pain that intensifies with deep breathing and coughing
Immediate medical attention is required. |
|
|
Term
| PT Management Acute Venous Dysfunction |
|
Definition
Bed rest with affected lower extremity elevated
In later stages, graded ambulating with pressure-gradient stockings or elastic bandages
Educate in strategies to prevent DVT’s |
|
|
Term
|
Definition
Exercise to enhance pumping of blood
Compression stockings and/or sequential compression unit
Keep LE’s elevated when immobile |
|
|
Term
| Chronic Venous Dysfunction |
|
Definition
Inadequate venous return over a long period of time due to damaged or incompetent valves
Symptoms: dependent edema with aching and tiredness; over time, venous stasis ulcers |
|
|
Term
| PT Management Chronic Venous Dysfunction |
|
Definition
Important to manage lymphedema secondary to venous dysfunction -See Box 24.10, p.837
Compression bandages
Custom pressure-gradient support stockings
Regular active exercise
Rest & sleep with involved limb(s) elevated
Avoid prolonged periods of having limb(s) dependent without active movement
Mechanical compression and manual lyphatic drainage (massage)
Skin care and wound management |
|
|
Term
|
Definition
Comprehensive approach to management
Manual lymphatic drainage: massage very different from traditional massage
Exercise & elevation of the limb
Compression
nonelastic or short stretch bandages
compression garments
mechanical compression
Skin care and hygiene |
|
|
Term
| Mechanism of injury for ACL |
|
Definition
Non-Contact: a forceful hyperextension of the knee
OR Occurs when the foot is planted and the tibia externally rotates on the planted foot
Because the ACL is lateral on femur, the femur moving internally, tibia moves externally = taut
Contact: Blow to the lateral side of the knee resulting in a valgus force |
|
|
Term
|
Definition
| The PT will flex the knee to 90 degrees, the foot planted, and grasp proximal tibia and direct an anterior force. If the tibia displace forward in reference to the femur, then an ACL may be considered injured. |
|
|
Term
|
Definition
| The knee flexed to 30 degrees, foot not planted. Grasp proximal tibia and direct the force anteriorly. |
|
|
Term
| Degrees of stability for ACL injuries |
|
Definition
Mild instability = Grade 1+ (5 mm or less of joint surface separation)
Mod instability = Grade 2+ (4 - 10 mm or separation)
Max instability = Grade 3+ (10 mm or more of separation) |
|
|
Term
| Indications for ACL surgical repair |
|
Definition
Complete tear of ACL
Abnormal anterior translation
Instability or buckling of knee |
|
|
Term
| Weight bearing with ACL repair |
|
Definition
Ambulation with crutches PWB
WB progressed next 2-3 weeks
If pt has active knee extension and good quadricep strength to control the knee
By two weeks post-op brace worn unlocked during ambulation |
|
|
Term
| Graft Healing with ACL repair |
|
Definition
The tendon-bone graft is actually strongest at time of implantation
The tendon goes through necrotizing process first 2-3 weeks
Revascularization gradually occurs
Healing of bone plugs complete by 6 weeks |
|
|
Term
| Protective movement with ACL repair |
|
Definition
A period of protective movement is necessary so proper vascularization and tensile strength of connective tissue can increase
At 2-3 weeks
Graft weakest & slightly necrotic
Avoid Activities that caus Anterior Tibial Translatation = AT&T
Avoid Open Chain Terminal Extension
30 - 0 degrees (SAQ)
Avoid Deep Squat
60-90 degrees
Avoid too vigorous exercises which can stretch or damage repaired structures
Do exercises in protected range |
|
|
Term
| What muscle can control AT&T? |
|
Definition
Hamstring muscle is the dynamic stabilizer of the knee
Pulls the tibia posteriorly
= decreases ATT
Do Quad sets in sitting with foot on floor doing co-contraction of hamstrings
Do chair scooting for hamstring strength |
|
|
Term
| Maximum Protection Phase with ACL repair |
|
Definition
To Regain mobility:
CPM used 1st week after surgery
0-90 degrees (do not use calf strap)
PROM
Patellar glides to prevent adhesions
Gravity assisted wall slide (Assist involved leg to extension due to ATT)
Heel slides |
|
|
Term
| exercises with acl max protection phase |
|
Definition
Exercise begin day after surgery
Remove brace for muscle setting & ROM exercises
Use Electrical Stimulation for VMO
Wear brace for WB activities
SLR’s in 4 positions using BRACE LOCKED at 0°
Early motion must be controlled to avoid stretching the graft in the early stages |
|
|
Term
| Why do you avoid squatting ex between 60-90 degrees in max protection phase |
|
Definition
| Increases ATT and can disrupt the graft because the tibia moves anteriorly |
|
|
Term
|
Definition
Progress weight bearing
Mini squats should be done so that the knees do not move anterior to the toes
Increase shear forces on tibia and can stress autograft |
|
|
Term
| Moderate Protection Phase in ACL repair |
|
Definition
Begins 4-5 weeks post-op
Pain is controlled
Flexion to 125 degrees
Protective brace worn for gait exercises
By 8 weeks revascularization of graft well-established & exercise can be performed more vigorously
Continue to avoid open chain terminal extension
And closed chain extension exercises between 60-90 degrees
CKC exercises
Mini squats,lunges, step-ups, leg press
PRE
Balance activities |
|
|
Term
| Minimum Protection Phase with ACL repair |
|
Definition
11- 24 weeks post op
Functional activities
Wear unlocked brace
Plyometrics, jumping, hopping, agility drills |
|
|
Term
| Return to Sport with ACL repair |
|
Definition
6 months
Muscle function 70% of uninvolved
Functional bracing for high demand activities |
|
|
Term
| Mechanism of Injury in PCL injury |
|
Definition
Pt falls on flexed knee
Drives tibia posteriorly
Stress PCL and tears ligament |
|
|
Term
| Indication for Surgery with PCL injury |
|
Definition
Complete tear of PCL
Rotary instability
Many pt can return to pre-injury level without surgery |
|
|
Term
| Progressing Weight Bearing in PCL repair |
|
Definition
PWB with crutches using protective brace
4-6 weeks longer than ACL
FWB by 8 - 10 weeks
Pt needs adequate quadriceps strength |
|
|
Term
| Maximum Protection Phase in PCL repair |
|
Definition
Exercises begin immediately after surgery
Multiple–angle isometrics of quadriceps
From full extension to 30 degrees of flexion
SLR
Progress to active knee extension
Progress to CKC mini-squats
Postpone active knee flexion AG 6 weeks
Extends for 4-6 weeks
Protect graft
Regain mobility
Regain quadriceps control
During this phase regain 90 degrees of flexion by 2-4 wks PASSIVELY |
|
|
Term
| Protect Graft in PCL repair |
|
Definition
Protect the healing graft
During first 6-12 weeks all avoid all ACTIVE AG knee flexion exercises
= Posterior Tibial Translation (Passive OK) |
|
|
Term
| Regain Mobility with PCL repair |
|
Definition
Knee flexion exercises in sitting
Start in extension & control flexion (eccentric quads)
Apply slight overpressure to tibia to assist PASSIVE flexion
Patellar glides |
|
|
Term
| Moderate Protection Phase with PCL repair |
|
Definition
Criteria: Minimal pain and active full knee extension (no extensor lag)
At least 100 degrees passive knee flexion
Focus on Quadriceps strengthening
Hip & ankle musculature for functional WB activites
Strengthening of knee flexors is delayed up to 2 – 3 months |
|
|
Term
| Advance Rehabilition with PCL repair |
|
Definition
Postpone vigorous functional activities for at least 9 – 12 months
May be wearing a brace for high demand activities |
|
|
Term
| Return to sport with PCL repair |
|
Definition
Takes 9 months or longer to return to recreational activities
= 3 months longer than ACL |
|
|
Term
| Most common orthopedic injury in geriatrics? |
|
Definition
|
|
Term
| What are hip fractures attributed to? |
|
Definition
|
|
Term
| How are hip fractures descibed? |
|
Definition
Femoral neck (intercapsular)
Intertrochanteric fracture (extracapsular)
Sub trochanteric fracture (proximal femur) |
|
|
Term
| Surgical interventions with Hip fractures |
|
Definition
ORIF
Hemireplacement
Total Hip Replacement
Arthroplasty |
|
|
Term
| Three main complications of hip fractures |
|
Definition
Malunion
Delayed union
Nonunion avascular necrosis (AVN) |
|
|
Term
Postoperative management of Hip fractures
Acute care setting |
|
Definition
Acute care setting:
Get pt up an moving to prevent effects of prolonged bed best & thrombus
Protect surgical stabilized fracture
Teach moving safely in bed
Transfer w/ correct WB status
Ambulation with assistive device
Edema control
Bed positioning
Deep breathing exercises |
|
|
Term
|
Definition
|
|
Term
|
Definition
Passive, skilled manual therapy techniques
Applied to joints
At varying speeds and amplitudes
To restore joint play
Allowing normal joint movement
Which restores normal ROM |
|
|
Term
|
Definition
Joint mobilization is a safe, effective way to restore "joint play"
Joint play is the “give” in the joint capsule which allows the bones to move
Required for full ROM |
|
|
Term
| Shoulder Capsular Pattern |
|
Definition
Greatest loss of lateral rotation
Moderate lose of abduction
Need to stretch joint capsule
To Treat motion loss
Do Joint Mobilization using Grade 3 |
|
|
Term
|
Definition
|
|
Term
|
Definition
Capsular pattern for Elbow joint limitation
Greater limitation of flexion than extension
Mild restriction:
Lose 15 degrees of flexion
Lose 5 degrees of extension
ROM: 5 to 130
Moderate Restriction:
Lose 30 degrees of flexion
Lose 10 degrees of extension
ROM: 10 – 115 degrees |
|
|
Term
|
Definition
Movement of bones due to the shape of the bony surface
As the bony lever moves about an axis of motion there is also movement of the bone surface on the opposing bone |
|
|
Term
| Arthrokinematics Movements include |
|
Definition
Rolling
Sliding
Spinning
Compression
Distraction |
|
|
Term
|
Definition
Surfaces are incongruent
New points on one surface meet new points on the opposing surface |
|
|
Term
|
Definition
Rolling results in swing
Rolling is always in the same direction direction of the moving bone
Rolling causes compression to the side the bone moving
The more incongruent joint surface the more rolling of bony partner |
|
|
Term
|
Definition
| Passive stretching used alone to increase joint ROM puts stressful force on the cartilage due to compression resulting in joint damage resulting from angular motion = roll |
|
|
Term
|
Definition
Pure slide occurs if:
= both surfaces are congruent
= both surfaces flat OR both round
The same point on one surface comes in contact with new points on opposing surface |
|
|
Term
|
Definition
NO
There is NO pure slide in the joints because the opposing surfaces are incongruent
The more congruent the joint surface, the more sliding movement |
|
|
Term
|
Definition
1 surface convex, 1 surface concave
Majority of bones |
|
|
Term
|
Definition
convex in one direction, concave other direction
Thumb CMC joint |
|
|
Term
| The direction in which the sliding occurs depends on whether the moving bone is |
|
Definition
Convex - rounded outward like a ball
Concave - dipped inward like a cave |
|
|
Term
|
Definition
The direction the moving bone slides depends on whether the MOVING bone is convex OR concave
Sliding is in the OPPOSITE direction if the moving bone is CONVEX.
Sliding is in the SAME direction if the moving bone is CONCAVE.
If the moving bone is convex, the therapist will slide or GLIDE the bone manaully in the normal direction it moves during active movement |
|
|
Term
|
Definition
| Separation of joint surfaces at right angles to the non-moving bone. |
|
|
Term
|
Definition
Stimulates movement of synovial fluid
Brings in nutrients to articular cartilage
Decreases pain
Inhibit the transmission of nociceptive stimuli = Gate Theory
Provides sensory input for awareness of joint in space = Proprioception
Use Grade 1 or 2 |
|
|
Term
| reversal of Jt hypomobility |
|
Definition
Stretches peri-articular tissue (capsule)
Stretches adhesions
Use Grades 3 or 4 |
|
|
Term
|
Definition
| small amplitude rhymthic oscillations performed at the beginning of the range |
|
|
Term
|
Definition
| larger amplitude performed within the range |
|
|
Term
| Jt mobs used to decrease pain |
|
Definition
|
|
Term
|
Definition
| larger amplitude rhythmic oscillations stressed into tissue resistance |
|
|
Term
|
Definition
| small amplitude rhythmic oscillations performed at limit of available motion and stressed into tissue resistance |
|
|
Term
| Jt mob for stretch tissue |
|
Definition
|
|
Term
| Rate of oscillation for grade 2 or 3 jt mob |
|
Definition
| 3 per second for 1 or 2 minutes |
|
|
Term
|
Definition
Painful joints, reflex muscle guarding, muscle spasm = use Grades 1 & 2 to decrease pain
Joint Hypomobility = use Grade 3 & 4 to elongate hypomobile capsule
Progressive joint diseases - use Grades 1 & 2 to maintain existing ROM (cannot change disease process but can minimize pain and reduce the effects of limitations) |
|
|
Term
| If the pt response to mob is increased pain and inflammation |
|
Definition
jt mob applied too vigorously
lead to a continued decrease in ROM due to inflammation process |
|
|
Term
| contraindications for jt mob |
|
Definition
Do not use Grades 3 & 4 (stretching techniques) on:
Hypermobile joints
Joint Effusion
Inflammation
Necrosis of ligaments or capsule |
|
|
Term
| Precautions for Jt mob stretching technique |
|
Definition
Malignancy
Bone disease (osteoporosis)
Unhealed fractures
Excessive pain
Hypermobility in associated joints (stabilize)
Elderly
Total joint replacement
Newly formed connective tissue (after surgery)
Pt using corticosteroids
Rheumatoid arthritis |
|
|
Term
|
Definition
Pt and extremity positioned so that pt can relax and muscle crossing joint relaxed
Position the joint in the resting position
Loose pack position = greatest capsular laxity for most movement of bone |
|
|
Term
|
Definition
Firmly & comfortably stabilize the proximal bone
Stabilization may be provided by a belt, one of the therapist’s hands, or an assistant holding the part
Stabilization make the stretch force more effective |
|
|
Term
| direction of movement for jt mob |
|
Definition
Direction of movement is perpendicular to the treatment plane for distraction
Direction of movement is parallel to the treatment plane for glides Glide in the direction the slide would normally occur (use convex-concave rule)
The entire bone is moved so that there is gliding of one joint surface on the other
DO NOT use the bone as a lever |
|
|
Term
| procedures for Distraction and glide |
|
Definition
Apply joint distraction (traction) at a right angle to the treatment plane for 1-2 minutes
Apply a glide to improve limiting motion for 1-2 minutes
End with distraction for 1-2 minutes
Begin and end with distraction with joint in resting position |
|
|
Term
|
Definition
Active exercise during which a static or dynamic muscular contraction is resisted by an outside force that may be applied manually or mechanically
Resistance exercise is used to improve muscle performance which can be impaired by disease, inactivity, injury, and immobilization. |
|
|
Term
|
Definition
| greatest measurable force that can be exerted by a muscle or muscle group to overcome resistance during a single maximum effort |
|
|
Term
|
Definition
| work produced by a muscle per unit of time; rate of performing work |
|
|
Term
|
Definition
| ability of a muscle to contract repeatedly against a load, generate & sustain tension, and resist fatigue over an extended period of time |
|
|
Term
|
Definition
| A muscle must perform at a level greater than that to which it is accustomed in order for performance to improve |
|
|
Term
|
Definition
To maintain the the changes in strength and endurance, improvements must be regularly used for functional activities or a maintenance program must be undertaken.
Use it or lose it. |
|
|
Term
| SAID Principle: Specific Adaptation to Imposed Demands |
|
Definition
| Specificity of training: Effects of training are specific to the training method. Whenever possible, exercise should match the requirements and demands placed on a patient for specific functional activities. |
|
|
Term
Type I muscle fiber
(tonic or slow twitch) |
|
Definition
| slow rate, low force force production; slow to fatigue |
|
|
Term
Type IIA & IIB
(phasic; fast-twitch) |
|
Definition
| rapid high force production, rapid fatigue |
|
|
Term
| Length-tension relationship |
|
Definition
| Muscle produces greatest tension when it is at or near its physiological resting position at the time of contraction |
|
|
Term
|
Definition
Concentric: increase speed, decrease tension
Eccentric: increase speed, increase tension |
|
|
Term
| Physiologic Adaptations to Resistance Exercise |
|
Definition
Hypertrophy of muscle fibers
Debatable whether muscle fiber numbers increase
Increased tensile strength of tendons, ligaments, and connective tissue in muscle |
|
|
Term
| Contraindications to Resistance Exercise |
|
Definition
Pain
Inflammation
Severe cardiopulmonary dz with acute symptoms |
|
|
Term
| Precautions for resistance exercise |
|
Definition
Valsalva maneuver
Overtraining
Overwork
Delayed-onset muscle soreness (DOMS)
Substitute motions
Osteoporosis |
|
|
Term
| Manual Resistance Exercise |
|
Definition
Resistance is applied by the therapist
Can be applied throughout the range of motion or in a small arc of motion
Can result in isometric, concentric, or eccentric contractions |
|
|
Term
| Mechanical Resistance Exercise |
|
Definition
| Resistance is applied by using some type of equipment, such as a free weight, Theraband, a rebounder, wall pulley, or treadmill |
|
|
Term
| Progressive resistance exercise (PRE’s) |
|
Definition
a constant external load is applied to a contracting muscle by a mechanical means and is incrementally progressed
Basis for PRE’s is the RM
Many of the PRE programs are based on early work done by DeLorme |
|
|
Term
| Plyometric (also called stretch-shortening drills, stretch-strengthening drills, or reactive neuromuscular training) |
|
Definition
High velocity resistance training characterized by rapid eccentric (elongating) contraction followed by a rapid reversal of movement with a resisted concentric (shortening) contraction of the same muscle
Uses the stretch reflex to develop muscle contraction speed
Patient must be ready for high intensity, task-specific, high-velocity dynamic exercise |
|
|
Term
|
Definition
Programs must use device that maintains a constant velocity of limb movement
Not practical for early stages of rehabilitation in most hospital settings
More on isokinetic will be covered in a lab later in the semester, Exercise for Advanced Stages of Recovery |
|
|
Term
|
Definition
| Muscle contracts but there is no appreciable change in length and no visible joint motion. |
|
|
Term
| Types of isometric exercise |
|
Definition
Muscle setting: low intensity isometric contraction; not really a resistance exercise because there is no resistance applied; will not increase strength except in a very weak muscle
Multi-angle (multi-arc): resistance is applied at multiple joint angles within a ROM
Stabilization: co-contraction around joints in weight bearing and antigravity positions |
|
|
Term
| Dynamic constant external resistance (DCER) |
|
Definition
| limb moves through ROM against a constant weight but the tension or force generated by the muscle must change as the joint angle changes |
|
|
Term
|
Definition
| resistance equipment imposed varying levels of resistance to muscles to lead the muscle more effectively at different points in the range |
|
|
Term
| Concentric/eccentric dynamic exercise |
|
Definition
| joint movement occurs with either acceleration (concentric) or deceleration (eccentric) of body segments as external resistance is overcome or controlled |
|
|
Term
| Force generated to control a given load: from greatest to least |
|
Definition
| Eccentric > isometric > concentric |
|
|
Term
| Motor unit recruitment to control a given load: from greatest to least |
|
Definition
| Concentric > isometric > eccentric |
|
|
Term
| Effort & energy stores expended to control a given load: from greatest to least |
|
Definition
| Concentric > Isometric > eccentric |
|
|
Term
|
Definition
Distal segment moves in space
no predictable joint motion in adjacent jts
movemnt of body segments only distal to the moving jt
muscle activation predominately in prime mover and muscles of the moving jt
Typically performed in NWB positions
resistance applied to the moving distal segment
use external rotary loading
external stabilization usually required |
|
|
Term
|
Definition
Distal segment fixed in place
Relatively predictable movement patterns in adjacent jts
movement of body segments both distal and proximal
muscle activation in multiple muscle groups, distal and proximal to the moving jt
typically performed in WB positions
resistance applied simultaneously to multiple moving segments
use to axial loading
internal stabilization by means of muscle action, jt compression & congruency, and postural control |
|
|
Term
| How do you know when to stop an exercise treatment session? |
|
Definition
Decreased range during the movement
Decreased rate of movement
Gross in-coordination
SOB
Increased sweating beyond what expected
Pallor
Substitutions
Increased pain
Muscle trembling
Pain or cramping where there was none before |
|
|
Term
|
Definition
| A therapeutic maneuver designed to increase flexibility of soft tissues and improve ROM by elongating structures that have become adaptively shortened and are hypomobile. |
|
|
Term
|
Definition
Ability to move a joint or series of joints smoothly & easily through unrestricted, pain-free range of motion
Flexibility exercises include stretching exercises to increase range of motion |
|
|
Term
| What is required for dynamic flexibility, but does not ensure it |
|
Definition
|
|
Term
|
Definition
Adaptive shortening of soft tissue associated with a joint or series of joints that results in significant limitation of range of motion
Named by the action of the shortened muscle
Example: elbow flexion contracture = cannot fully extend elbow |
|
|
Term
|
Definition
Musculotendinous unit has adaptively shortened and there is significant loss of ROM
No specific pathological problem
Reduction in number of sarcomere units
Resolved in a relatively short time with stretching |
|
|
Term
| Irreversible contracture (fibrotic) |
|
Definition
Permanent loss of extensibility of soft tissues
Normal muscle tissue and connective tissue replaced with fibrotic adhesions, scar tissue, and nonextensible tissue
Changes occur after long periods of time in shortened position or after significant trauma with related inflammatory response |
|
|
Term
| Arthrogenic or periarticular contracture |
|
Definition
Result of intra-articular pathology
Result of changes in tissue crossing or attaching to a joint |
|
|
Term
| Pseudomyostatic contracture |
|
Definition
Result of hypertonicity: muscle or muscles in a constant state of contraction secondary to CNS lesion
Result of muscle spasm = guarding & pain
Can use inhibition techniques to reduce muscle contractions and elongate muscles |
|
|
Term
|
Definition
| tissue returns to original size and shape once the stress is removed |
|
|
Term
|
Definition
| tissue yields because the bonds between individual fibers are broken |
|
|
Term
| Mechanical Response to Stretch |
|
Definition
Stretch force transmitted to muscle fibers via connective tissue
Longitudinal force causes tension in the elastic component
Cross-bridging of filaments disrupted
Results in lengthening of sarcomeres = SARCOMERE GIVE |
|
|
Term
|
Definition
The sarcomere give and subsequent elongation is transient if the muscle is allowed to resume its previous length
Therefore, have patient perform active exercises and functional activities in the newly acquired range. |
|
|
Term
|
Definition
sensitive to changes in muscle length
gives CNS information about muscle length & rate of change in length |
|
|
Term
|
Definition
sensitive to changes in muscle tension
gives CNS information to control amount of force |
|
|
Term
|
Definition
Stretching well beyond the normal ROM. Results in:
stretch weakness
joint instability from lack of support & muscle weakness |
|
|
Term
|
Definition
| Allowing tightness to develop in some muscles while increasing length in others to improve function |
|
|
Term
|
Definition
Regain or re-establish normal ROM
Prevent irreversible contractures
Increase flexibility in conjunction with strengthening exercises
Minimize the risk of musculotendinous injuries |
|
|
Term
| Hold time/# of reps for stretching |
|
Definition
Let off overpressure momentarily after each 60 second stretch to allow patient to rest briefly
DO NOT let extremity move back into shortened range
Repeat 3 - 4 times |
|
|
Term
|
Definition
Patient does an isometric contraction of the tight muscle (muscles)
Uses the concept of the GTO firing to inhibit its own muscle (autogenic inhibition) |
|
|
Term
|
Definition
Have patient do an active contraction of the muscle which does the motion that is restricted
Uses the concept of reciprocal inhibition
Gentle technique for early stage of healing or painful muscle that is tight |
|
|
Term
| Hold-Relax with Agonist Contraction |
|
Definition
Have patient do an isometric contraction of the tight muscle, then do an active contraction of the muscle which does the motion that is restricted
Using reciprocal inhibition |
|
|
Term
|
Definition
MUSCLE SORNESS OR JOINT PAIN LASTING MORE THAN 24 HOURS AFTER STRETCHING MEANS TOO MUCH FORCE WAS USED
INFLAMMATION IS OCCURRING
THIS WILL INCREASE SCAR FORMATION AND DECREASE ROM |
|
|
Term
| Low Load, Long Duration Stretching |
|
Definition
Uses the response of CREEP
When a load is applied for an extended period of time the tissue elongates and results in a permanent deformation of tissue.
The lesser the load applied for a longer period of time will result in greater deformation. |
|
|
Term
|
Definition
Patient control proximal areas of the body
while maintaining alignment
and a stable position
while carrying out functional activities |
|
|
Term
|
Definition
Activated with bracing maneuver
Provides segmental stability |
|
|
Term
|
Definition
Activated with bracing maneuver
Stabilizes against rotation |
|
|
Term
| Stability and positioning is required in |
|
Definition
proximal structures:
TRUNK & NECK
LOW BACK & HIPS
SHOULDER GIRDLE |
|
|
Term
| Line of gravity shifts forward |
|
Definition
| Erector spine eccentrically contract to prevent trunk flexion |
|
|
Term
| Line of gravity shifts backward |
|
Definition
| Abdominals and psoas major eccentrically contract to prevent trunk extension |
|
|
Term
| Line of gravity shifts laterally |
|
Definition
| Contralateral muscles Quadratus lumborum, internal/external obliques eccentrically contract |
|
|
Term
|
Definition
leads to increase hip flexion and L/S extension
Muscles: iliopsoas and back extensors (ES & lats)
Active hip flexion will result in anterior pelvic tilt & increased lumbar extension unless the abdominal & hip extensor stabilize |
|
|
Term
|
Definition
ACTIVE hip flexion = APT and L/S Extension
UNLESS pelvis stabilized by trunk flexors (abd) |
|
|
Term
|
Definition
leads to increase hip extension and L/S flexion
Muscles: hip extensors (gluts) and trunk flexors (abd)
Posterior Pelvic Tilt = results in hip extension & lumbar spine flexion |
|
|
Term
|
Definition
ACTIVE hip extension = PPT & L/S Flexion
UNLESS pelvis stabilized by abdominals and Erector Spinae |
|
|
Term
|
Definition
Results in elevation of the hip on one side and hip drop on opposite side
Muscles causing this motion:
1) quadratus lumborum on elevated side
2) reverse pull of gluteus medius on lowered side
Lumbar spine convexity toward the lowered side because trunk flexes toward elevated pelvis
Passive support from ITB on elevated side |
|
|
Term
| Dynamic Support for the Lumbar spine |
|
Definition
Increase tension on fascia
Increases participation of the other structures attached to it
Increase it support with equalizing structures |
|
|
Term
|
Definition
Muscles attachments into the thoracolumbar fascia provide stability to lumbar spine
Fascia from latissimus dorsi attaches to the spinous process |
|
|
Term
|
Definition
| Contraction of the latissimus dorsi increases the force to the fascia to provide an anti-flexion movement |
|
|
Term
|
Definition
| Transverse abdominis and Internal obliques have a structure attached to them called the LATERAL RAPHE which attaches them to the spinous process. |
|
|
Term
|
Definition
Because the TA & IO attach to the spinous process contraction of these muscles have an effect on spinal movement
Contraction of the TA & IO increases tension on the lateral raphe which is transmitted to the fascia which also provides counterflexion |
|
|
Term
|
Definition
| Contraction of the TA & IO increases intra-abdominal pressure which increases tension on the lateral raphe |
|
|
Term
|
Definition
The lateral fibers of the external obliques assist in maintaining PPT (neutral spine) during leg raising.
If the external obliques are weak the pelvis tilts anteriorly as the legs are lifted or lowered and the back hyperextends |
|
|
Term
| GUIDELINES TO DEVELOP STABILITY |
|
Definition
Patient aligned
Isolate and develop STATIC strength & endurance
Begin movements stabilizing in SINGLE plane
Progress to DIAGONAL movements
Add CLOSE CHAIN activities
Graduate to FUNCTIONAL ACTIVITIES
& BODY MECHANICS
Develop endurance with repetitive controlled stresses |
|
|
Term
| DYNAMIC STABILIZATION TECHNIQUES |
|
Definition
1) Control functional position in supine
2) Develop strength and endurance in muscles that stabilize the spine
3) Need a balance of muscle strength
4) Develop proximal strength by holding the trunk still and the spine in neutral position while doing simple extremity movements |
|
|
Term
| Requirements for Dynamic Stabilization |
|
Definition
MOBILITY for proper placement for alignment
STRENGTH of muscles to HOLD a position need
ENDURANCE to hold position for prolonged periodsof time, i.e. work
BALANCE to hold position while moving out of BOS
COORDINATION to make adjustments and timing |
|
|
Term
| Treatment techniques for abdominal bracing |
|
Definition
Patient performs active APT/PPT end ranges
Find neutral position
Neutral position = functional position = safe spine
Perform Abdominal Bracing
Have pt hold 30 seconds
When pt able to hold abdominal bracing for 3 minutes
Progress pt to simple arm/leg movements
Progress exercises by increasing lever arms
Decrease BOS |
|
|
Term
|
Definition
| reconstructive joint procedure, with or without implant |
|
|
Term
|
Definition
| both articulating joint surfaces removed and replaced |
|
|
Term
|
Definition
| one articulating joint surface removed and replaced |
|
|
Term
| General Indications for jt replacement |
|
Definition
Severe pain in the joint
Instability, decreased ROM, & decreased strength resulting in decreased function
Marked deformity
Fractures followed by avascular necrosis
Joint destruction
Failure of a previous surgical procedure |
|
|
Term
| Realistic goals of jt replacement |
|
Definition
Relief of pain
Increased function
Patient should expect modifications in activities and life-style |
|
|
Term
| For any joint replacement, the treatment protocol is dictated by |
|
Definition
type of surgical procedure
components used
surgeon’s preferences and skill |
|
|
Term
| Preoperative Management of jt replacement |
|
Definition
Educate the patient about the surgery and expectations after the surgery
Strengthen muscles surrounding the joint
Gait train with the assistive device likely to be used immediately after the surgery
Educate about post-surgical exercise and precautions |
|
|
Term
| Posterolateral approaches to Hip Replacement |
|
Definition
AVOID
Hip flexion greater than 80-90 degrees (some physicians have more conservative restrictions)
Adduction beyond neutral
Internal rotation beyond neutral |
|
|
Term
| Anterolateral approach to Hip replacement |
|
Definition
AVOID
Hip extension beyond neutral (hyperextension)
Hip flexion greater than 90 degrees
Hip adduction beyond neutral
Hip external rotation beyond neutral
Combined hip flexion, abduction, external rotation |
|
|
Term
| Lateral approach to hip replacement |
|
Definition
AVOID
Hip extension beyond neutral (hyperextension)
Hip flexion greater than 90 degrees
Hip adduction beyond neutral
Hip external rotation beyond neutral
Combined hip flexion, abduction, external rotation |
|
|
Term
| Anterior approach to hip replacement |
|
Definition
|
|
Term
Maximum Protection – post-op day 1 to week 3-4
Hip Replacement |
|
Definition
Deep breathing, coughing, and ankle pumps
Active ROM and resisted exercise on unoperated UE’s & LE
Muscle setting exercises – quad sets, glut sets
Bed mobility and transfers, with hip precautions
Gait training with appropriate weight-bearing status – emphasis on safety, posture re-education, and endurance for discharge
Prevent contractures on operated LE – especially hip flexion contractures
Active-assisted progressing to active ROM exercises on operated hip in protected ranges with emphasis on gaining control & mobility for ADL’s
Progress exercises from bed to chair to standing to closed-chain with only allowable weight on LE |
|
|
Term
Moderate Protection – week 4 to week 6-8
Hip replacement |
|
Definition
Continue hip precautions
Progress active ROM gradually in protected ranges (if trochanteric osteotomy, avoid anti-gravity abduction)
Emphasize endurance and control of hip muscles with active and very light resistance exercises (early on, abduction and extension are gravity eliminated)
Progress closed chain exercises as weight-bearing increases – emphasis on proprioception and kinesthesia
Gait training to gain control, correct faulty gait patterns, & correct posture
Reduce any contractures – premorbid hip flexion contractures are common |
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Term
Minimum Protection – week 6-8 to max potential
Hip Replacement |
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Definition
Continue light weight, high repetition PRE’s (some sources recommend 60-80% of RM for adequate strength)
Emphasize closed chain exercises for postural control
Encourage walking, swimming, cycling and other low impact activities
Transition to less supportive AD per physician & PT |
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Term
Max Protect for TKA
wks 1-4 |
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Definition
Pian modulation modalities
compression wrap to control effusion
ankle pumps
AAROM and AROM
Muscle setting(quads, hamstrings, and adductors)
patellar mob grades 1 and 2
flexibility program hamstrings, calf and IT band
trunk/pelvis strengthening
gait training |
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Term
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Definition
patellar mob
Le stretching prog
closed-chain strength
Limited range PRE
Tibiofemoral jt mob
proprioceptive training
stabilization ex
gt training
protected aerobic ex |
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Term
Min protect for TKA
wks 8 and beyond |
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Definition
cont as previous and advance as appropriate
implement ex specific to functional tasks |
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Term
| Exercise precautions for TKA |
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Definition
No SLR in side-lying 2 weeks after cemented or 4-6 weeks after cementless
During knee flexion, monitor incision for excessive tension
Physician should make determination for initiation of resistance exercises (may be 2 weeks to 3 months)
Unsupported or unassisted weight-bearing requires sufficient hamstring & quadriceps strength to stabilize the knee
Avoid vigorous passive stretching: What are options for stretching that are safer for the patient?
Goal in first 4 weeks or sooner is knee flexion 0-90 degrees and full extension.
Often will have extensor lag of 10 degrees early in rehab
Emphasize active quadriceps control |
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Term
Reverse ball and socket
TSR |
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Definition
Used with patients with completely deficient rotator cuff or failed previous TSR
Ball is attached to the scapula and the socket is attached to the humerus.
Allows the patient to use the deltoid more efficiently as a elevator of the arm |
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Term
Max protect phase for TSR
day 1 - wk 6 |
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Definition
emphasize erect standing and sitting with scapula positioned well for stability of the GH joint
active ROM neck & scapula, elbow, wrist, and hand on operated side to minimize muscle guarding
PROM and therapist-assisted ROM without immobilizer
progress to self-assisted ROM sitting and standing
scapular stabilization exercises non-weight-bearing
pendulum exercises, no weight added, elbow flexed |
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Term
Mod protection phase TSR
wks 6-12/16 |
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Definition
continue to apply precautions of RCR if necessary
progress from AAROM to AROM all planes
open-chain active exercises in all positions
scapular stabilization with progressively more weight-bearing
multi-angle isometric exercises with gentle resistance
strengthening exercises from 0-90 degrees elevation with light resistance – start supine to stabilize scapula and progress to sitting
increase shoulder and scapular muscle endurance
During all exercises emphasize movement with good scapular and thoracic alignment. |
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Term
Min Protect with TSR
wks 12/16 to several months |
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Definition
continue RCR precautions as necessary
gentle end-range self stretching
PRE’s through available range: low load, high reps
progressive closed chain UE exercises to develop shoulder girdle stability
replicate functional movements when performing resistance exercises |
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Term
| Spinal disk replacement contraindications |
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Definition
Multi-disc involvement
Vertebral instability
Poor bone quality
Facet joint damage
History of previous spine surgery
Infection
Pregnancy or planning to get pregnant |
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Term
| Rehabilitation for Lumbar or Cervical Disc Replacement |
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Definition
Pain relief
Body mechanics and positioning to protect the area involved
Gentle stretching if needed
Emphasis on stabilization exercises for spine and scapulae |
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