Exercise OTA skills 2

closed chain exercise

- motions in which the body moves on a distal segment that is fixed or stabilized on a support surface; movement at one joint cause simultaneous motions at distal as well as proximal joints in a relatively predictable manner; performed in weight bearing positions

strength training (theraputty, theraband, therabars)

- provide stimulating enviro, rest between sets -explain procedures ,reps smooth/controlled -for a 2+ or 3 muscles, position limb to move in a gravity reduced plane -for a 3+ or above muscles, position limb to move against gravity

Muscle contraction

-actin and myosin (calcium influx and crossbridges)

info for oxford and delorme method

-both may be modified -delorme has advantage of warming up muscle more gradually -oxford may have advantage of maximizing muscle exhaustion - both equally effective to achieve overload (maybe pt preference)

Elements of Coordination

-contraction of agonists -relaxation of antagonists -co-contraction of joint stabilizing muscles -Kinesthesia > proprioception> body schema -control of muscle tension -postural tone, balance

Nystagmus

-involuntary movement of eyeballs -can interfered with balance

Ankylosis

-is a stiffness of a joint due to abnormal adhesion and rigidity of the bones of the joint -may be able to be prevented but may also be avoidable in some disease processes

Rebound Phenonmenon of Holmes

-lack of check reflex -released arm projects forcefully

Guidance Cues:

-touch, auditory, visual

Functional endurance training

-usually engage clients in occupations at approx. 50% of their max work capabilities -progressively increase time

Guidance Use hand contact at:

H-O-H, H-O-W, H-O-E

Muscular endurance training

active exercise will increase the endurance of a muscle if: -performed repeatedly -against a moderate load -to the point of fatigue -low-load/ high reps -strengthening of muscle will also increase endurance

progressive resistive exercise

based on overload principle -muscles perform more efficiently if given warm up period and must be taxed beyond usual daily activity to improve in performance and strength -delorme method -oxford method

Oxford method aka- descending pyramid

determine max resistance (MR) -- therapist should estimate amount of resistance client can take based on muscle test results and add or subtract resistance until client can perform sets of repetitions adequately. Educated trial and error -perform 3 sets at 100%, 75%, and 50% of MR

active insufficiency

when a joint cannot be moved through further ROM bc a muscle has contracted as far as it can

passive insufficiency

when a joint cannot move any further (in it's range of motion) because a muscle has stretched to its limit

PNF stretching techiques

- Hold-relax --> isometric hold, then stretch after isometric contraction --based upon principle that muscles relax more after a hard contraction -contract-relax --> contraction away from stretch with muscle that is being stretched, then stretch --based upon principle of reciprocal inhibition

Sternal precautions. Why?

- cardiac surgery requires cutting through the sternum. the sternum is vulnerable while healing from this trauma

Congestive Heart Failure Class 3- moderate heart failure

- marked activity limitations. consistent shortness of breath, heart palpitations, and/or anginal pain with less than ordinary activity. Pt is comfortable at rest

muscle principles

- muscles have an optimum length at which they are capable of generating the most tension - for most muscles this optimum length is near midpoint between maximally short and maximally long -muscles that are on a slight stretch can contract more forcefully

Pacemaker precautions precautions 4-6 wks after placement:

- no therex to involved shoulder -limit shoulder flexion and abduction to 90 deg - NO UE weight bearing > 10-15lbs -NO lifting > 5lbs -No driving until cleared by MD

pulley exercises (shoulder wheel, therapy bars)

- one arm can assist the other (AAROM) -stretching -- contraindicated for CVA pt's > 90 degrees due to decrease scapular motion ---> impingement -good for eccentric shoulder work

Common pts for endurance

- post hospitalization -long term debility -recovery from surgery -COPD -cardiac

Dyssynergia

-"decomposition of movement" - Voluntary movements are broken down into component parts and feel jerky

Therapeutic exercise

-(97110) includes activities related to strengthening, endurance training, ROM, and flexibility (can include use of free weights, exercise machines such as treadmills/ ergometers, and ROM exercises: PROM/AROM) -(97530) utilize dynamic activities to improve functional performance. think of this as the "ing" code (ex: lifting, pulling, pushing, running, and jumping)

Coordination Problems (13)

-Ataxia, Adiadochokinesia, Athetoid movements -Ballism, Choreiform movements, -Dysmetria, Dyssynergia, Dysarthria, Dystonia -Nystagmus, -Rebound Phenonmenon of Holmes, Spasms, Tremors

TX ideas for endurance

-Exercycle (restorator, UE bike) -Modified aerobics -- theraband/wrist weights/dumbells --make fun, be encouraging --keep pt aware of time periodically --participation/ simultaneous motion will engage and assist w/ initiation of motion

Endurance

-ability to continue activity in spite of stress; to delay the onset of fatigue

Reversibility principle

-adaptive changes in the body's system in response to a resistance exercise program are transient unless training-induces improvements are regularly used for functional activities

hammer wrist and hand exercises

-adjust resistance by hand placement on shaft -wrist RD, UD, and supination

Exercise recs (precautions)

-aerobic exercise should include large muscle activities w/ an intensity of perceived exertion score between 11 and 14 out of 20. ideally a min of 3x/wk is recommended -strength training should include circuit training w/ high reps and low resistance 3 days a week. Functional exercises should also be included

Diabetes precautions

-aware of hypoglycemia (glucose level <90) -- may need glucose tablet/ snack -be sure pt is wearing well fitting/appropriate and comfortable socks if ambulating --foot irritations can lead to a serious infection -pt should drink fluids if doing extended exercise to prevent dehydration which can cause blood sugar levels to rise

Edema

-can limit ROM/ cause stiffness -can be controlled via: -- active muscle action(pumping function) -- compression - elastic strips/ tubular bandages --positioning above head

Ataxia

-delayed initiation of motor responses -errors in range and force of movements -errors in rate and regularity of movements

Delorme method aka- ascending pyramid

-determine max resistance (MR) -- therapist should estimate amount of resistance client can take based on muscle test results and add or subtract resistance until client can perform sets of repetitions adequately. Educated trial and error -perform 3 sets at 50%, 75%, and 100% of MR

sternal precautions

-don't lift more that 8lbs (ex. gallon of milk) -don't push/pull w/ your arms when moving in and getting out of bed, hold breath during activity -don't flex/extend your shoulders over 90 degrees -avoid reaching too far across your body, twisting or deep bending, long periods of over shoulder activities - no driving until cleared by surgeon -brace your chest when coughing or sneezing. this is vital during 1st two weeks at home - report any clicking/ popping noise around your chest bone to your surgeon right away

Coronary Artery Bypass Graft (CABG) precautions

-encourage deep breathing (opens alveoli and increases O2 exchange) -METS -cardiac rehabilitation

joint mobilization

-externally imposed -small amplitude passive motion that is intended to produce gliding or traction at a joint

precautions/ contraindications (therex)

-extremely poor general health -acutely inflamed joints, acute infections -immediately following some type of surgery -well established permanent contractors -some types of exercise should NOT be performed in instances where there is an absence of voluntary control of isolated motion or those who can't control dyskinetic movement

Dystonia

-faulty muscle tension or tone -produce grotesque posturing with bizarre writhing movements

Dysarthria

-faulty speech production

stretching

-gentle prolonged: best --however gains can also be noted using 15-30 sec stretch -residual pain after stretching indicates that stretch was too forceful and caused tearing of soft tissue/blood vessels

Coordination

-harmonious interaction of muscle allowing for accurate controlled movement -smoothness, rhythm, appropriate speed

Diabetes precautions cont'd

-if the pt has diabetic retinopathy --straining, holding breath/ vigorous exercise can cause hemorrhaging in eye and retinal detachment -some pts will have autonomic neuropathy, which affects the unconscious controls of the body for temp, BP, digestion --body may not adapt appropriately to some levels of exercise

Dysmetria

-inability to estimate distance of reach

Adiadochokinesia

-inability to perform rapidly alternating movements -difficulty dusting or washing windows

safety precautions related to passive stretching

-inflammation weakens the structure of collage tissues --those tissues must be stretched cautionly with slow, gentle motion -sensory loss prevents the pt from monitoring pain -- pay close attention to the tension of tissues being stretched -overstretching must be avoided -- causes internal bleeding and scar formation, even ossification

Tremors

-involuntary shaking or trembling - intention tremor: during movement -resting tremor: when not moving -- pill rolling: pt appears to be rolling pill between thumb and index/middle fingers (parkinson's)

principles of stretching cont'd

-make sure movement is in the line of pull of the muscle -encourage pt to assist in moving limb if possible -hold the limb at point of max stretch 15-30 sec --longer stretching should be at less than max, even minimal tension for periods longer than 30 min -relief of discomfort should immediately follow the release of stretch

Training Coordination Cont'd

-mental fatigue occurs rapidly bc pt is required to concentrate intensely. provide frequent short rest breaks -don't permit pt to repeat incorrect/ uncoordinated patterns. -instead, 1. have pt rest, 2. determine source of error, and 3. reinstruct

Body system changes during exercise

-more blood flow to muscle -increased HR -increased respiration depth -increased O2 consumption

Body system changes Long term changes

-more blood vessels in muscle -heart able to pump more blood per beat (increased stoke volume and output) -decreased resting HR -HR returns to normal quicker after exercise

open chain exercise

-motions in which the distal segment (hand/ foot) is free to move in space w/o necessarily causing simultaneous motions at adjacent joints; limb movement only occurs distal to the moving joint and muscle activation occurs in the muscles that cross the moving joints

Congestive Heart Failure Class 1- Basically Asymptomatic

-no activity limitations. No shortness of breath or heart palpitations. Pt suffers no symptoms from ordinary activities

Congestive heart failure (precautions) -stop or slow exercises when pt is:

-overly fatigued, SOB, not feeling well -dizzy/lightheaded, rapid/irregular heartbeat (if it's still above 120-150 beats per minutes after 10 min, call doctor) -in pain (heart pain or elsewhere) -has any cardiac symptoms (chest pressure, pain, etc)

Notify médical personnel when:

-pitting edema -decrease in HR of 10bpm or decrease in BP of 10mmHG -increase in respiration rate to greater than 40 respirations per minute -rating of perceived exertion (RPE) increasing above 14/20 (moderate exertion) -increased pulmonary rales (sounds of rattle or crackling) or dyspnea -diaphoresis (sweating, usually profuse), pallor and/or confusion

Ballism

-projectile movements -continuous, gross, abrupt contractors of trunk and proximal limb muscles

golgi tendon organ

-proprioceptors that are located in the tendon adjacent to the myotendinous junction -protect the muscle by causing to relax when it senses too much stress on muscle

principles of stretching

-provide relaxing environment for pt -describe manual stretching, noting that it involves tolerable pain -stabilize the bone proximal and distal to the joint to be moved -move the bone smoothly, slowly and gently to the point of maximal stretch (mild discomfort indicated verbally or facially be the pt)

Training Coordination

-pt able to learn, follow directions, cooperate& concentrate -eliminate distraction: pt will have to "listen" carefully to their own bodies -practice one component of a given motion at a time -reduce speed and resistance to keep effort low so that other muscles (outside targeted pattern are not excited. Keep speed SLOW)

Stretching during occupation

-pt may be more relaxed if engaged in interesting activity and motivated to participate in task -research show subjects who participated in ROM dance made more significant gains in ROM than subjects who did transitional home program -Look for compensations!!

Tx guidelines for endurance

-pt not able to increase intensity, try increasing frequency -mangage pt's daily activity schedule to make progressively more exerting -incorporate fun and comradery where possible - watch pt closely!! (Dyspnea, increased HR, skin changes such as flushing/redness, ℅ light headedness) STOP/ MAKE ADJUSTMENTS CONSERVATIVELY AS NEEDED.

Congestive heart failure (precautions) -avoid these exercises (do NOT exercise a CHF pt who has had recent unexplained weight gain: pt maybe retaining fluids as a result of CHF)

-push-ups, sit ups, and isometric exercises -heavy lifting, pushing heavy objects, and chores such as raking, shoveling, mowing, and scrubbing -outdoor exercise when hot or cold (warmth reduces endurance/ cold increases demands on heart)

manual resistance

-push/pull exercises --horizontal plane --- vertical plane

General endurance Training

-relates to the effective transport and use of O2 -exercise usually directed to large muscle groups in rhythmical patterns -prolonged (15-16 min @ 60-90% of max HR) -frequency varies ( 3/5x/wk) -adequate rest is important

pt tolerance

-respiratory capacity, cardiac capacity, -pain/discomfort, inflammation -conditioning, other factors

Congestive Heart Failure Class 4- Severe heart failure

-severe to complete activity limitations. Pt may be confined to bed/wheelchair. discomfort/ severe symptoms with any activity. symptoms may be present at rest

therapeutic exercise in a Tx plan

-should NOT be arbitrarily assigned -should be reflective of thoughtful application of theory --should be evidenced based -should be curtailed to needs of individual -- should reflect critical reasoning - goals and documentation must reflect functional outcomes --should be reflective of our practice framework -should be continual monitored for tolerance and appropriate dosage

Hypertension (HTN) precautions

-similar to CHF -encourage regular breathing (don't hold breath- Valsalva effect causes steep rise in BP)

Congestive Heart Failure Class 2- Mild heart failure

-slight and mild activity limitations. some shortness of breath or heart palpitations with activity. comfortable at rest or with mild exertions

Athetoid movements

-slow wormlike, arrhythmical movements -"writhing movements" -fluctuations in muscle ton

Muscle spindle

-special receptor within muscle -determine the amount contraction necessary to overcome a given response

SAID principle

-specific adaptation to imposed demands; body systems adapt over time to stresses placed on them. need to train each pt to their own individual goals

Compensation Principles

-stabilize objects being worked on -stabilize proximal body parts -use assistive devices that reduce slipperiness or provide stability -use heavy utensils, tools, etc -wrist weights -use adaptations that substitute for lack of fine skill

Spasms

-sudden, involuntary contractions of a muscle of large groups of muscles

Choreiform movements

-uncontrolled, purposeless movements -common in "huntington's chorea" -huntington's chorea: degenerative neurological disease usually begins in pts 40s and ends in death w/in 15yrs

types of endurance

1. Muscular: ability of muscle to contract repeatedly and sustain tension over a prolonged period of time 2. General: ability to sustain low intensity exercise 3. Functional: ability to perform goal directed daily living activities for prolonged periods of time. May entail various intensities (light, moderate, intense)

elements of therapeutic (therex)

1. psychological preparedness 2. intact joints and muscles 3. pain-free articulations 4. joint flexibility 5. increase muscle strength 6. increase muscle endurance 7. increase muscle speed 8. increase agility and coordination 9. increase C-V endurance

Hypertension (HTN) when performing resistance training for pt's, follow these guidelines from the American Heart Association

1. single set of 8 to 10 different exercises (e.g. chest press, shoulder press, triceps extension, biceps curl, latissimus pull-down, lower ack extension, abdominal crunch, leg press, leg curls and heel raise) 2. perform 2-3 days per week 3. repetition zone of 10-15 attaining moderate fatigue (ratings of perceived exertion of 12 to 13 or somewhat hard) 4. progress gradually and DO NOT PERFORM ISOMETRIC EXERCISES