Movement science 2 final review

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- 3 stances 1. Feet together 2. SLS non-dominant LE 3. Tandem non-dominant LE back - Count errors: higher error score = poorer balance

FIRM surface

- 3 stances - Count errors: higher error score = poorer balance 1. Feet together 2. SLS non-dominant LE 3. Tandem non-dominant LE back

FOAM surface

- Posture - Disease - Meds (drugs and alcohol) - Deconditioned state - Disuse, injury or surgery - Fatigue

Factors affecting balance

- Stage of tissue healing (later stages of subacute or in settled stage) - Underlying pathology - Severity of impairment - Comorbilities - Ability to cooperate and learn - transition from rehab setting to home/gym based program

Factors to consider in resistance training

- COG over fixed BOS on stable surface

static balance

- Visual - Vestibular - Proprioception

what are the environmental factors in regards to balance/postural equilibrium?

- Increased functional activity - Reduce cardiac demands

AHA/ASA resistance training benefits

- Weak in the paretic and non paretic extremity - Decreased functional activity - Increased sedentary lifestyle - Preservation of eccentric torque

AHA/ASA resistance training considerations for patients post-stroke

Stroke survivors 2-3 days/week - Strength: 50 to 80% 1 RM, 1 to 3 sets of 10 to 15 reps

AHA/ASA resistance training recommendations

- A cooler environment at the lower end of the range is recommended to avoid overheating

APTA guidelines for Aerobic conditioning in hydrotherapy

- 78 to 96 degrees F for flexibility, strengthening, gait training, and relaxation

APTA guidelines for mobility and functional control exercise in hydrotherapy

- Tepid 78.8 to 95 degrees F (26-35 degrees c) - 82-88 degrees F for active patients or those with MS - 88 to 92 degrees F for less active patients and those with arthritis or women - 92 to 96 degrees F for less active patients

APTA guidelines for temperature regulations in hydrotherapy

- Max resistance through range - Concentric or eccentric - Accommodates for pain - Exercise at functional speeds - Used for research - Used for patient testing

Advantages of isokinetic exercise (resistance exercise)

- Establish quantitative baseline measurements - Used when strength exceeds therapists strength - Appropriate when strength 4/5 or greater - Adds variety to training program - Improves strength and endurance

Advantages of mechanical resistance exercises

B. More muscle tension

As the arm with the weight becomes more perpendicular to the line of gravity, you will have _____? A. Less muscle tension B. More muscle tension C. Equal tension

- Configuration of BOS - COG alignment over BOS - Speed of postural movement - Ability to maintain a position - Ability to voluntarily move - Ability to react to perturbation

Balance will depend on

Coordinated muscle action in the kinetic chain

Balanced is controlled by

- Our LE's function primarily in CKC - CKC activity: increased load to the joints stimulates mechanoreceptors and encourages functional muscle co-contractions - Damage to mechanoreceptors due to injury will adversely affect proprioception

CKC exercises with balance

- DOMS (delayed onset muscle soreness): Onset 24-48 hours, lasts 3-4 days, tissue damage, repeated bout effect. - Greater force production --> greater stress on tendon

Cautions when using eccentrics

Posture

Center of buoyancy in hydrotherapy changes with ...

Affected side

Center of buoyancy in hydrotherapy: A amputation patient in supine rolls to the ____ side

- Eccentric > isometrics > concentric - Concentric contractions: Force production proportional to number of motor units recruited - Eccentric contractions: Requires less motor unit recruitment. Non-contractile components supply resistance

Characteristics and effects of dynamic resistance exercise: Force production and mechanical efficiency

- Eccentric training: > More mode specific than concentric > More velocity specific > Transfer of training is limited

Characteristics and effects of dynamic resistance exercise: Specificity of training

- Fast velocities under maximum load: > Eccentric contraction tension increases slightly and then plateaus > concentric contraction tension rapidly decreases

Characteristics and effects of dynamic resistance exercise: Velocity of exercise and force generating capacity

- Patient position can be altered to emphasized concentric or eccentric bias strengthening exercise - Limited to muscle grades > 3/5

Clinical application of free weights with dynamic resistance training

- Concentric training emphasizes local circulation and increases capillary density - Eccentric training: > Initiated 2-3 weeks post injury or post operatively during maturation phase (muscle strain, post-op tendon repairs, and ACL reconstructions) > Tendinopathy: Optimizes collagen repair

Clinical applications of dynamic resistance exercise training

- Fragile or healing skin - Malignant sites - Cellulitis or infected areas - Known tape allergies

Contraindications for kinesiotaping

"Use it or lose it"

Deconditioning/ disuse in balance

- Flotation belt - Vests - Flotation dumbbells - Noodles - Fins - Specially designed boots - Bells - Buoyant dumbbells

Deep water equipment

Force generated at the front of the object during movement

Define bow force in hydrotherapy

- Expensive - Time consuming

Disadvantages of isokinetic exercise (resistance exercise)

- Non functional - Single plane of movement Compensations - Expensive

Disadvantages of weight machines with resistance exercises

- Surface tension/ flow motion - Eddy Drag: currents along side an object > Provides resistance to movement and is influenced by speed > Resistance of the water adjacent to the skin > Increases with speed of motion > Modified by surface area

Drag forces and hydrotherapy

- Requires attention - Specific to activity or sport - Such as: colored balls, specific commands/rules, may incorporate specific equipment

Dual task activity for balance

- COG over moving BOS (feet) usually on stable surface

Dynamic balance

- Frontal plane - Multidirectional

Dynamic trunk stabilization with hydrotherapy

- DLS firm/stable > soft/unstable (EO/EC, perturbations) - SLS firm/stable surface > soft/unstable

Early progression to consider for balance

- Gloves, paddles, and barbells are examples of equipment designed for the water that can assist in increasing the resistance against the water

Equipment that influences drag in hydrotherapy

- Skipping - Power skipping - Backward skipping - Side skipping - Split squats - Single leg hops for distance

Examples of bounding in plyometrics

- Lateral bounding (quick step valgus loading) - Slide bounds - Spin jumps - Cycle jumps - Five-dot drill

Examples of in-place activities

- Quick shortening of the muscle and tensioning of the musculotendinous unit - i.e: upward jumping - Power= force X velocity - High energy expenditure

Explosive movements of eccentrics

- Important prerequisite for plyometric training because a high amount of stress is applied on the MSK system - Should begin with general warm up and flexibility exercise program. - Flexibility program should address muscle groups involved with plyometric program. Should include static and short dynamic stretching techniques (from book Pg 273)

Flexibility (general and specific) with plyometrics

- Concentric contraction: force decreases as speed increases. Lose control because you don't have time to control - Eccentric contraction: force increases as speed increases.

Force-velocity curve

- Frequency: > Optimum frequency is unknown > General guideline, allow 48-72 hours of rest between plyometrics training sessions - Training age: > Younger = keep demand lower

Frequency and training age for plyometric program design

- Based on goals of rehab program - Integrate MSK and neural system - Progress level of difficulty

Functional strengthening and resistive exercise

- Requires sufficient healing, adequate ROM, strength, and flexibility - Semi-dynamic > dynamic - DLS > SLS or weight transfer using semi-dynamic - Typically involves a return to rest position - Slow speed > fast speed - Low force > high force - Controlled > uncontrolled Activity/sport specific

Further progression tips for balance

- Guide (ipsilateral) hand directs patient's body as muscles contract to move the body through water - Resistance (contralateral) hand is placed at the distal end of the contracting segment

Hand placement in manual resistance exercises with hydrotherapy

- Hip extension - Hip ER - Hip IR

Hip stretching techniques utilized in hydrotherapy

- Extremity strengthening exercises - Lumbar spine strengthening - Trunk strengthening exercises (standing, semi-reclined, supine, prone, in deep water)

Independent strengthening exercises in hydrotherapy

Yes - Acute, subacute, settled, post surgical, injury prevention

Is kinesiotaping a modality that is appropriate for any stage of the treatment plan?

The following is TRUE about free weights

Is this statement true or false i regards to free weights: " The line of resistance is set in the plane of gravity, vertically ceiling to floor"

- % of max voluntary contraction (MVC) to improve strength - 6 to 10 second holds - Physiological overflow is minimal (10 degrees in each direction) - Mode specific

Isometric training for dynamic resistance training

0-15% tension = Lymphatic and pain application 15-25% tension = Muscle lengthening/ relaxation 25-35% tension = Muscle strengthening/ facilitation 50-75% tension = Mechanical correction techniques 75-100% tension = Ligament techniques

Kinesiotaping tension

- Knee extension with patient on steps - Knee flexion with patient on steps - Knee flexion with patient supine - Hamstring stretch

Knee stretching techniques utilized in hydrotherapy

- Hip ABD/ ADD - Hip flex with knee flex - Hip IR/ ER - Knee ext - Ankle motions - Ankle DF / PF - Ankle inversion/ eversion

Lower extremity manual resistance techniques utilized in hydrotherapy

1. *Paper-off tension*: C. The fabric is applied to the paper with different tensions making this tape variable 2. *Amount and quality of adhesive*: A. Using more adhesive and more aggressive adhesive makes it difficult to tape many populations 3. *Quality of elastic*: B. A wide variety of flexibility, resilience, and adaptability requires different application methods

Match the following terms to their definitions: (Elastic therapeutic tapes) 1. Paper-off tension 2. Amount and quality of adhesive 3. Quality of elastic A. Using more adhesive and more aggressive adhesive makes it difficult to tape many populations B. A wide variety of flexibility, resilience, and adaptability requires different application methods C. The fabric is applied to the paper with different tensions making this tape variable

1. *Target Tissue*: B. Tissue requiring treatment 2. *Proximal*: D. Origin 3. *Distal*: A. Insertion 4. *Tension*: E. Longitudinal deformation of the K-Tape (%) 5. *Stretch*: C. Position of the body or excursion of the skin to limit folds

Match the kinesiotaping term with its definition: 1. Target Tissue: 2. Proximal: 3. Distal: 4. Tension: 5. Stretch: A. Insertion B. Tissue requiring treatment C. Position of the body or excursion of the skin to limit folds D. Origin E. Longitudinal deformation of the K-Tape (%)

1. *Anchor*: D. - Beginning of application, 0% tension applied in neutral position. 2. *End*: B. - Last part laid down, 0% tension applied in stretching position 3. *Therapeutic Zone*: A. - Zone between anchor and end; applied to target tissue 4. *Therapeutic Direction Recoil*: C. - K-Tape recoil toward the anchor or towards the center (50% of tension or below)

Match the kinesiotaping term with its definition: 1. Anchor: 2. End: 3. Therapeutic Zone: 4. Therapeutic Direction Recoil: A. Zone between anchor and end; applied to target tissue B. Last part laid down, 0% tension applied in stretching position C. K-Tape recoil toward the anchor or towards the center (50% of tension or below) D. Beginning of application, 0% tension applied in neutral position.

- MDT for compression - I strips or Y strips - 50% to 75% tension with inward/downward pressure - Apply rule of thirds

Mechanical correction with K-tape

- Specially designed socks - Force current - Elastic tubing - Noodles - Kick board

Mid water equipment

- Postural equilibrium - Postural/tightness - Phasic/weakness - Paired relationships

Muscle balance and posture

- Amount of stretched force applied - Absolute fiber strength: greater tensile strength = less elongation - Ability of muscle spindle to elicit response: low sensitivity = less powerful response

Muscle fiber elongation is dependent on (plyometrics)

- Reflexes - Reaction times

Neuromuscular system exercise for posture

- Proprioceptive stretch reflex: > Muscle spindles > Muscle belly: responds to magnitude/velocity of stretch > consider knee jerk response - Golgi Tendon Organ (GTO): > Tendon; response to tension

Neurophysiologic characteristics of plyometric

(refer to picture)

Number of foot contacts by season for jump training (plyometrics)

- Romberg: Feet together, eyes closed, hands at side. Qualitative and subjective - Balance error scoring system: > FIRM surface > FOAM surface > Count errors: higher error score = poorer balance - SL hopping test - Kinesthesia - Other balance tools (Tinetti balance test, BERG balance assessment, etc.) - Be creative based on functional needs

Outcome measures for postural equilibrium/ balance

- Training should be specific to the individual's goals - Activity specific movement patterns should be training - Sport specific skills should be broken down and trained in their smaller components and then rebuilt in to a coordinated activity specific movement pattern - Greatest benefit at conclusion of normal workout - When proper technique can no longer by demonstrated, max volume has been achieved

Plyometric guidelines

- Pertinent in neurological patients - Pertinent in orthopedic patients

Position sense and kinesthesia

- Buoyancy assistive motions: the limb is moved/lifted up towards the water surface - Buoyancy supported motion: The water supports the limb in a horizontal plane - Buoyancy resisted motion: Opposes buoyancy and the limb is moved downward from the water surface

Principles of buoyancy exercises

- Don't need full WB to begin proprioceptive training - Should have adequate strength, flexibility, and ROM - Should have adequate static balance before going to dynamic - Should have DSL before SLE: EO before EC (EC enhances somatosensory control of balance, especially on unstable surfaces) - May add perturbations - May progress sets/reps or time

Progression tips for balance

- Emphasize the eccentric or landing phase - Absorb shock of landing through the ankle, knee and hip joint

Proper landing for plyometrics

- Quick and coordinated muscle response helps to protect joint from injury - Proprioception is the center of performance and function - Static postion sense - Dynamic position sense (kinesthesia)

Proprioception and balance rehab

- Feedback from peripheral mechanoreceptors such as muscle spindles and golgi tendon organs

Proprioception environmental factors of balance/postural equilibrium

- Rest time between sets - Work: Rest ratios - Power training = 1:3-4 - Endurance training = 1:1-2

Recovery for plyometrics program design

- Ratio of the mass of a given volume (patient) to the mass of the same volume of water - Object with a relative density > 1 sinks - Object with relative density < 1 floats - Object = 1 floats on the water - Humans specific gravity = <1 (0.95-0.874)

Relative density/specific gravity of buoyancy in hydrotherapy

- Balance is a skill - Balance is functional - Function: integrated, coordinated, efficient, multidirectional movement - Proprioception: sensorimotor system (key to joint homeostasis)

Restoration of balance

- Always begin with an orthopedic screening evaluation - Develop an adequate strength base - Always use good supportive shoes - Always use good resilient surfaces - Have a proper organized progression - Train with knowledge supervision to ensure proper technique

Safety requirements for plyometrics training

- Shoulder flexion and ABD - Hip flexion - Knee extension - Knee flexion

Self stretching with aquatic equipment

- COG over fixed BOS on unstable surface - Transfer COG over fixed BOS on stable surface

Semi-dynamic balance

- Shoulder flexion - Shoulder ABD - Shoulder ER - Shoulder IR

Shoulder stretching techniques utilized in hydrotherapy

- Prolonged foot contact - Lack of arm/leg movement - Reduced vertical height or horizontal distance - Longer rest periods - Lack of synchronous head and trunk control - Loss of interest

Signs of fatigue and overtraining with plyometrics

- Drop in performance - Loss of appetite - Lack of energy - Elevated resting HR - Elevated BP - MUSCLE TENDERNESS - Sleep disturbances - Frequent illness

Signs of overtraining in resistance exercise

- Clean and dry skin - Free from oils or creams - Clip or shave any dense or matted hair

Skin preparation for kinesiotaping

- Facilitate ROM exercise - WB modification - Provide 3 dimensional access to the patient - Modulate MSK pain - Improve/maintain muscle strength, power, and endurance - Improve/maintain balance, coordination, and agility - Optimize body mechanics and postural stability - Improve flexibility - Facilitate gait and locomotion and cardiovascular exercise - Enhance cardiopulmonary function - Initiate progressive functional activity replicating movement patterns: less stress, more support, more control - Minimize risk of injury or re-injury

Specific goals of aquatic therapy

Water holds 4 X's as much thermal energy than air

Specific heat of water in water hydrotherapy

- Weight bearing - Oscillations - Isometrics

Stimulation of mechanoreceptors for posture

- Time - Magnitude of the stretch - Velocity of the stretch - Should be short range, without delay

Stored elastic energy in plyometrics (pre stretch)

- Isolate - Function - SAID principle - Overload principle

Strength and endurance for posture

D. Mechanical correction techniques

The "I" and "Y" strips are best used for what? A. Lymphatic and pain application B. Muscle lengthening/ relaxation C. Muscle strengthening/ facilitation D. Mechanical correction techniques E. Ligament techniques

D. Kenzo Kase - Developed over 25 years ago in Japan

The kinesiotaping method was developed by who? A. Jamies Winston B. Mike Evans C. Kenny Kase D. Kenzo Kase

E. Fan strip

This image illustrates what type of K-Tape basic cuts? A. Y strip B. I strip C. X strip D. Web strip E. Fan strip

A. Step 1 --> Assess

This image BEST illustrates which step for the application of kinesiotaping? A. Step 1 B. Step 2 C. Step 3 D. Step 4

- Tissue decompression relieves pressure from the free nerve endings in the tissues that are responsible for nociception (pain), so it can immediately reduce perceived pain. - The decompression action of the tape allows for better circulation to and from the area taped, reducing swelling at the site of an injury, which likely contributes to the performance and recovery effects

Tissue decompression with kinesiotaping

True

True or False (aquatic therapy and HR): The greater the immersion, the greater the decrease in HR

- Registers the orientation and movement of the head: Semicircular canals (fluid-filled canals), Otoliths (contains crystals), Each of these change/move in response to head motion or position bending cilia that send a neural stimulus. - Response: > Eye movement- vestibulo-ocular reflex: maintain a stable point of visual fixation during head movement, equivalent eye movement in opposite direction > Postural movement via spinal cord- vestibulo-spinal reflex: Postural stability and balance/postural equilibrium

Vestibular environmental factors of balance/postural equilibrium

- Friction occurring between molecules of liquid resulting in resistance to flow - Water provides resistance to a limb moving in the water - Resistance is in the opposite direction - Resistance is 12 X's the resistance of air

Viscosity and hydrotherapy

- Measures the perception of the orientation of the head/eyes and self-motion to the environment - Gives feedback to the other systems about what is happening in the environment (focal vision and peripheral vision)

Visual environmental factors of balance/postural equilibrium

- Tension 0-50%, anchors and ends measure 1/2 - 1 block - Tension above 50%, anchors and end measure 1/3 the length of the tape

What is the rule of thirds in regards to K-tape?

1. Contractile component (CC): - Concentric contract = energy in SEC augments CC (contraction) 2. Parallel elastic component (PEC): - Passive force w/ unstimulated muscle stretch 3. Series Elastic Component (SEC): - Pre stretch = stores elastic energy in SEC

3 components of plyometrics (mechanical characteristics)

- Tension in the muscle develops and physical shortening of the muscle occurs as an external force (resistance) is overcome - Concentric contractions accelerate body segments

Concentric contractions for dynamic resistance exercise

B. McConnell & Mulligan Taping - Limits normal ROM - provides a therapeutic benefit by compressive forces to selected tissue

A patient comes in with a sprained ankle. You decide to use a taping technique that will limit the patients normal ROM. You want the taping to provide a compressive therapeutic benefit for the patient. Which of the following techniques would be BEST for you to use? A. Prophylactic Athletic Taping B. McConnell & Mulligan Taping C. McKenzie Method D. Kinesiotaping Method

D. Kinesiotaping Method - Allows normal ROM - Therapeutic benefits achieved by tissue glide, decompression, or compression - Can be work 3-5 days with good skin tolerance

A patient comes into the clinic with a sprained ankle. You want to utilize a taping technique that will allow the patient to have normal ROM and provide a compressive benefit. In the patient's medical history you see that they are allergic to latex. The patient has a follow up appointment in 3 days and you want the patient to wear the taping until their next visit. Which of the following taping techniques would be BEST to use? A. Prophylactic Athletic Taping B. McConnell & Mulligan Taping C. McKenzie Method D. Kinesiotaping Method

A. Prophylactic Athletic Taping - Acute injuries or injury prevention - Compressive force to joint, skin, and muscles - Not rehabilitative

A patient injured their ankle 1 day ago. They are in the acute stage. You want a taping technique that is NOT rehabilitative and that will add a compressing force to the joint. Which taping technique would be BEST for you to use? A. Prophylactic Athletic Taping B. McConnell & Mulligan Taping C. McKenzie Method D. Kinesiotaping Method

- External support - Single muscle or muscle group - Safe - Easy to document

Advantages of weight machines with resistance exercises

- Deep water walking/running - Mid water jogging/running (immersed treadmill running) - Immersed equipment - Swimming strokes

Aerobic conditioning treatment interventions for hydrotherapy

- A body is immersed in a fluid at rest, it experiences an upward thrust equal to the weight of the fluid displaced - The force is opposite to the direction of gravity - The amount of fluid displaced depends upon the density of the body relative to the density of the fluid

Archimedes principle

- Both eccentric and concentric training

Characteristics and effects of dynamic resistance exercise: Cross training effect

- Eccentric consumes less oxygen and energy stores than concentric contractions

Characteristics and effects of dynamic resistance exercise: Energy expenditure and metabolic efficiency

E. Both B and C are correct

Balance and postural equilibrium involves which of the following components. A. Vestibular B. Sensory C. Motor D. Muscular E. Both B and C are correct

- Balance master - Equitest - Biodex - PROPRIO reactive balance system

Balance assessment, rehabilitation and technology

- Static > semi-dynamic > dynamic - Body weight: sit > stand > weight shifts - BOS: bilateral > unilateral - Vision: eyes open > eyes closed - Surface: stable/firm surface> unstable/soft surface - Counter balance: extremities for counterbalance > no counter (arms out stretched > at side> crossed) - Shoes: On vs off - External physical stimuli: Perturbations - manual or self - Dual task: addition of cognitive challenge

Balance training progression (variables to manipulate)

D. All of the above are correct - Visual, vestibular, and proprioceptive

Balanced is sensed by which of the following: A. Visual B. Vestibular C. Proprioceptive D. All of the above are correct

Improve function, maintain bone mass, reduce cardiometabolic risk factor

Benefits of ACSM resistance training in sedentary or older adults beginning exercise program

Affected/ spastic

Center of buoyancy in hydrotherapy: A hemiplegic patient in supine rolls towards the ______ side in the water

Away from

Center of buoyancy in hydrotherapy: A patient with an edematous limb in supine rolls ____ the affected side

- Greater damage to muscle and connective tissue with eccentric exercise than concentric exercises (greater force production --> greater stress on muscle/tendon) - Onset 24-48 hours - Lasts 3-4 days - Repeated-bout effect - Progress gradually with eccentric exercise

Characteristics and effects of dynamic resistance exercise: Exercise induced muscle soreness (DOMS)

- Pulley rope is set perpendicular to the lever arm: > Concentric contraction: 20% past resting position (lengthened range of the muscle group) > Eccentric contraction: 30% past resting position (shortened range of the muscle group) - Axis/fulcrum or patient position can be altered to emphasize concentric or eccentric bias strengthening exercise - Ideal for most muscle grades - More versatile than free weights

Clinical application of pulleys with dynamic resistance training

- Minimal changes in distance can alter level of tension in the band or tube - Not consistent with length tension curve of the muscle - Matches length tension curve until the band is perpendicular to the lever arm - Beyond perpendicular towards the end of range, the band resistance continues to increase - To allow for full ROM, lighter load training

Clinical application of therabands/tubing for dynamic resistance exercise

- Patients with more muscle mass have a higher relative density and are more likely to sink - Patients with a high fat mass will have a lower relative density and are more likely to float - Relative density/specific gravity

Clinical applications of buoyancy in hydrotherapy

- As the speed of movement increases through the water, resistance to motion increases - Moving water past the patient requires the patient to work harder to maintain position - The PT can produce water movement towards the patient increases resistance (stirring water around the patient limb) - Clinical considerations: protecting limb/joint after injury/surgery. I.e: ACL or ACL acute injury do NOT increase drag

Clinical significance of DRAG in hydrotherapy

- Helps to reduce edema; aids in lymphatic circulation and venous circulation - Decreases cardiac demand and output - Centralizes peripheral blood flow

Clinical significance of hydrostatic pressure in hydrotherapy

- In warm water, heat is transferred to the patient more rapidly and with more energy - Conversely, in cool or cold water, heat is transferred from the patient to the water more rapidly and with more energy lost

Clinical significance of hydrotherapy

- Can be used to strengthen muscles - Water's viscosity creates resistance with all active movements. - Increasing the speed of movement increases the resistance - Increasing the surface area moving through water increases resistance

Clinical significance of viscosity in hydrotherapy

- Unstable angina and cardiac failure - Respiratory insufficiency (vital capacity < 1 L) - Severe PVD - Severe kidney disease - Incontinence bladder and bowel - Open wounds without occlusive dressing usage (colostomy and contagious skin infection) - Water and airborne infections - Active infections (fever) - Uncontrolled seizures - Allergic to chemicals in pools

Contraindications of hydrotherapy

- Base strength before extremity strength - Proximal stability before distal mobility - Neuromuscular system efficiency

Core strength and stability

A. Buoyancy supported

This picture illustrates the patient A. Buoyancy supported B. Buoyancy resisted

- Dynamic, integrative process involving neurological pathways and MSK responses - Alignment of joint segment to maintain COG over BOS/ limits stability (LOS)

Define Balance/ postural equilibrium

- Refers to the use of multi-depth immersion pools or tanks that facilitates the application of various established therapeutic interventions, including (stretching, strengthening, joint mobilization, balance/gait training, and endurance training)

Define aquatic exercise

Describes motion of the movement hand

Define direction of movement for manual stretching techniques in hydrotherapy

Describes motion of patient

Define direction of movement with manual resistance exercises in hydrotherapy

Muscle loading that involves external force application with tension increase during the lengthening of the musclotendinous unit

Define eccentrics

- A quick powerful movement involving a muscle pre-stretch to activate the stretch-shortening cycle to produce a stronger concentric contraction - Greek: Plyo (to increase), metric (to measure)

Define plyometric exercise

A type of bacteria (germ) that is found commonly in the environment, like in soil and in water

Define pseudomonas aeruginosa

Runs parallel direction to water surface

Define surface tension (cohesive forces) in hydrotherapy

- Joint strapping with limit pathological movement - Therapeutic benefit achieved by compressive force to selected tissues - Requires combo of tapes: extremely rigid tape placed over a cotton mesh tape - Limits normal ROM - Limited wear time - Latex and non-latex adhesives

Describe McConnell & Mulligan Taping technique

- Limits or assists motion in acute injuries or injury prevention - Compressive force to the skin, joint, and muscles - May require pre-tape or adhesive - Limited wear time - Often contains latex - Not rehabilitative

Describe the Prophylactic Athletic Taping technique

1-2 blocks applied with NO tension to abdomen or treatment area. Evaluate for sensitivity after a few hours or days

Describe the test patch for kinesiotaping

- Glut max: Initial contact - Glut med: Initial contact to terminal stance - Hamstrings: Initial contact to loading response; initial swing to terminal swing. - Quads: Initial contact to loading response; pre-swing to initial swing - DF: Initial contact to loading response - PF: midstance

Eccentric activity during the gait cycle

- Muscle lengthens under tension as the muscle attempts to control the load - Eccentric contractions decelerate body segments and act as a source of shock absorption during high impact activities

Eccentric contractions for dynamic resistance exercise

- Acute: Eccentric exercise NOT recommended. Isometrics are ideal - Sub acute: Sub max, slow speeds. Concentric contractions are better - Settled/chronic: Progress to max load, fast speeds - Save isokinetics eccentrics for final stage of rehab - Balance of joint play, flexibility, and strength

Eccentric work management guidelines for dynamic resistance training

- Need to increase tensile strength - Helps with tendinosis. Chronic degeneration of collagen.

Eccentrics for tendon injury

- 3 sets of 15 reps - 2x's day, 7 days a week - 12 weeks - Work through mild pain (5/10) - Able to increase load when no discomfort

Eccentrics with Achilles tendinopathy (article no one read)

B. Buoyancy resisted

This picture illustrates the patient A. Buoyancy supported B. Buoyancy resisted

- Muscular fatigue worsens or impairs joint position sense - May also affect NM control of joint (I.e: EMG studies)

Fatigue with balance and posture

- Muscles around joints must first stretch, then contract to produce explosive movement - Plyometrics enhances specificity of training - UE and LE training principles are the same but UE intensity = less due to smaller musculature and type of muscle function

General principles of plyometrics

- Monitor vitals - Seated if concerns of LOB

Geriatric age related recommendations with resistance training

- Specific purpose: Facilitate functional recovery by providing an environment that augments a patient's and/or practitioner's ability to perform various therapeutic interventions - The buoyancy, support, and accommodating resistance of aquatic environments enhance exercise and functional training for patients/clients across the age span with MSK, neuromuscular, cardiovascular/pulmonary, and integumentary diseases, disorders, or conditions

Goals and indications for aquatic therapy

- Decrease the amount of time required between the yielding eccentric muscle contraction and the initiation of the overcoming concentric contraction - Amortization phase - Stretch shorten cycle: mechanical characteristics and neurophysiologic characteristics

Goals of plyometric training

- Ankle is the most frequently injured - Injury to lateral ligaments of ankle= damage to joint proprioceptors because joint receptors fibers have less tensile strength then ligament fibers - Result= joint deafferentation = decreased input to afferent pathways = decreased proprioception = reinjury

How can an injury/surgery to the ankle affect one's balance?

- Posture - Core strength and stability - Stimulation of mechanoreceptors - Kinesthesia - Strength and endurance - Muscle balance - Neuromuscular system exercise - BALANCE

How do we get balance back?

- Rate of perceived exertion - HR

How do you monitor the intensity of exercise in hydrotherapy?

- Vision changes - Sensation changes - Neurological changes

How does disease affect balance

- Posture (neutral spine) affects balance, strength, and coordination - Postural equilibrium is crucial to balance

How does posture affect balance

- Fixed (ipsilateral) hand stabilizes the patient. positioned proximally on the affected extremity - Movement (contralateral) hand, positioned distally, guides patient's extremity through desired motion and applies the stretch force

How should a PT's hands be placed while utilizing manual stretching techniques in hydrotherapy?

1 RM= weight/ coefficient Ex: patient perofrms 12 reps of 35 lbs leg press -> 1 RM = 35/.703 (50 lbs)

How to determine 1 RM

- Pressure exerted by water on immersed objects - Arrows in image represent pressure

Hydrostatic pressure and hydrotherapy

- Superficial heat agent applied to the body or body parts - Sources of energy is mechanical and thermal (mechanoreceptor and thermoreceptors)

Hydrotherapy and superficial heat agent

A. Distal to proximal (therapeutic direction is the recoil of the tape toward the anchor) C. 15-25% tension

If a patient has an overactive muscle, how would you correct that using K-tape? (Select the TWO BEST answers) A. Distal to proximal B. Proximal to distal C. 15-25% tension D. 15-35% tension

B. Proximal to distal (therapeutic direction is the recoil of the tape toward the anchor) D. 15-35% tension

If a patient has an under-active muscle, how would you correct that using K-tape? (Select the TWO BEST answers) A. Distal to proximal B. Proximal to distal C. 15-25% tension D. 15-35% tension

C. Lean backward

If a patient is sitting upright and having difficulty moving into elbow flexion concentrically, what is the BEST way you could position the patient so the patient is able to get into midrange to resist the most force? A. Sidelying B. Lean forward C. Lean backward D. Stay sitting upright

B. Lean forward

If a patient is sitting upright and having difficulty moving into elbow flexion eccentrically, what is the BEST way you could position the patient so the patient is able to get into midrange to resist the most force? A. Sidelying B. Lean forward C. Lean backward D. Stay sitting upright

B. Muscle lengthening/ relaxation

If you apply the kinesiotape at 20% tension, you are helping with.. A. Ligament techniques B. Muscle lengthening/ relaxation C. Lymphatic and pain application D. Muscle strengthening/ facilitation E. Mechanical correction techniques

C. 25-35%

If you want to improve a patients muscle strength, how much tension would you apply to the kinesiotape? A. 0-15% B. 15-25% C. 25-35% D. 50-75% E. 75-100%

- Proprioception is useful - COG position over BOS not accurately sensed - If you effect feedback via trauma/ diagnosis/ deconditioning/ meds/ fatigue/ alcohol (effects the strategies and effects control up the kinetic chain)

Impaired balance

- Increased speed of the stretch reflex - Better recruitment of motor units - Desensitization of the GTO's - Neuromuscular coordination (improved coordination, enhancing nervous system to become more automatic)

Improving physiological performance in plyometrics

D. Starting position

In this image, A represents which phase of the stretch shorten cycle? A. Eccentric phase B. Amortization phase C. Concentric phase D. Starting position

A. Eccentric phase

In this image, B represents which phase of the stretch shorten cycle? A. Eccentric phase B. Amortization phase C. Concentric phase D. Starting position

B. Amortization phase

In this image, C represents which phase of the stretch shorten cycle? A. Eccentric phase B. Amortization phase C. Concentric phase D. Starting position

C. Concentric phase

In this image, D represents which phase of the stretch shorten cycle? A. Eccentric phase B. Amortization phase C. Concentric phase D. Starting position

A because it is perpendicular to the line of gravity.

In this image, where will muscle tension be at its max? A. A B. B C. C

B. A --> B - Concentric = going up from 0 to 90 degrees in this pic

In this image, which of the following points would illustrate a concentric contraction of the shoulder flexors? A. A--> C B. A --> B C. C --> A D. C --> B E. B--> C

E. B --> C - Eccentric = going from 90 to 180 degrees in this pic

In this image, which of the following points would illustrate an eccentric contraction of the shoulder extensors? A. A--> C B. A --> B C. C --> A D. C --> B E. B --> C

C. Step 7 --> target tissue on stretch with application tension

This image BEST illustrates which step for the application of kinesiotaping? A. Step 5 B. Step 6 C. Step 7 D. Step 8

1. Avoid excess inversion/ PF stress 2. Overcome inversion torque with reactive, strong, time critical motor strategies to counteract (achieved by appropriate proprioceptive input and training)

Inversion injury to the ATFL can be prevented if (balance and posture)

- I strip - X strip - Web strip - Fan strip - Y strip

K-Tape basic cuts

- The cable system is adjustable. Manipulation of the pivot point or axel - Imposes varying levels or resistance to contracting muscles to load muscles more efficiently at multiple points in the ROM based on length tension curve

Length tension concepts: adjustable cable system with dynamic resistance training

Weight-bearing percentages: - Water level at C7, patient is 10% WB - Water level to sternum (nipple line), patient is 33% WB - Water level to ASIS, patient is 50% WB

Percentage of body weight off-loaded with increasing immersion depth

- Decrease in BP - Increase in HR - Increase in CO - Increase in muscle metabolism

Physiological changes during warm water exercises

- Bradycardia during immersion (rest or exercise) for temperature equal or lower then 32 degrees C (89.6 degrees F) - gravity: blood flows from below the heart back up to it with less effort - Compression (hydrostatic pressure): Pressure water exerts on the body assists in venous load to the heart - Greater the immersion, the greater the decrease in HR - Identify the HR max in the water environment and determine bradycardia at rest in position, depth, and temp.

Physiological changes in HR during aquatic therapy

- Increased superficial local circulation - Increased metabolism - Increased temperature - Increased tissue extensibility - Decreased pain

Physiological effects of superficial heat

- Cardiovascular response - Training effect

Physiological response to deep-water walking/running

- External: > Increase external load= increased demand - Intensity: > Double leg-single leg > Increase load > Raise height of box/step - Volume: > Total amount of work done in a workout session > plyometrics = measure foot contacts > start low intensity (75-100 foot contacts) progress to low-mod intensity with 200-250 foot contacts

Plyometric program design Intensity vs external loads vs volume

- Pseudomonas aeruginosa - Cleaning and pH levels tests - Walking surfaces - Safety rules and regulations - Life preservers and CPR

Pool care and safety

- Same 3 sensory inputs: Visual, vestibular, and proprioceptive. - COG, BOS, alignment, trunk muscle recruitment, and hips

Posture requires input from

- Close supervision - Proper instructions and form - Appropriate modifications of progression and intensity

Pre-pubescent age related recommendations with resistance training

- Precautions: Valsalva maneuver - Contraindications: Cardiac disease and vascular disorders

Precautions and contraindications of isometric exercises for dynamic resistance training

- Diabetes - Kidney disease - CHF - Asthma - High or low BP - Primary lymphoedema - Swelling of internal organs - Open wounds - Pregnancy

Precautions for kinesiotaping

- Fear of water - Confusion/disorientation - Neurological disorders (ataxia, heat intolerance- MS, controlled epilepsy) - Respiratory disorders - Cardiac dysfunction (angina, abnormal BP, heart disease) - Small open wounds and tracheostomies

Precautions of hydrotherapy

D. Web strip

This image illustrates what type of K-Tape basic cuts? A. Y strip B. I strip C. X strip D. Web strip E. Fan strip

D. Step 6 --> Anchor tape to skin in neutral position (0% tension)

This image BEST illustrates which step for the application of kinesiotaping? (Step after rounding edges) A. Step 3 B. Step 4 C. Step 5 D. Step 6

B. Stretch shorten cycle

This image illustrates which cycle? A. Amortization B. Stretch shorten cycle C. Stored elastic energy D. None of the above

A. Prophylactic Athletic Taping

This image BEST illustrates which taping technique? A. Prophylactic Athletic Taping B. McConnell & Mulligan Taping C. McKenzie Method D. Kinesiotaping Method

B. McConnell & Mulligan Taping

This image BEST illustrates which taping technique? A. Prophylactic Athletic Taping B. McConnell & Mulligan Taping C. McKenzie Method D. Kinesiotaping Method

D. Kinesiotaping Method

This image BEST illustrates which taping technique? A. Prophylactic Athletic Taping B. McConnell & Mulligan Taping C. McKenzie Method D. Kinesiotaping Method

- Cervical spine lateral flexion

This image illustrates what stretching technique in hydrotherapy?

Shoulder ABD

This image illustrates what stretching technique in hydrotherapy?

A. Y strip

This image illustrates what type of K-Tape basic cuts? A. Y strip B. I strip C. X strip D. Web strip E. Fan strip

B. I strip

This image illustrates what type of K-Tape basic cuts? A. Y strip B. I strip C. X strip D. Web strip E. Fan strip

- Water transfers thermal energy 25 X's more rapidly than air at the same temperature - Higher temperature --> greater the effects - The greater body exposure, the greater the effects

Thermal conductivity in water hydrotherapy

B. Step 2 --> Develop problem list (ICF domains)

This image BEST illustrates which step for the application of kinesiotaping? A. Step 1 B. Step 2 C. Step 3 D. Step 4

C. Step 5 --> Round edges

This image BEST illustrates which step for the application of kinesiotaping? A. Step 3 B. Step 4 C. Step 5 D. Step 6

C. X strip

This image illustrates what type of K-Tape basic cuts? A. Y strip B. I strip C. X strip D. Web strip E. Fan strip

C. Medial-lateral loading - In place activities: Lateral bounding (quick step valgus loading) and slide bounds - Dynamic distance drills: Crossovers

This image is an example of what tissue specific loading using plyometrics? A. Shock absorption B. Deceleration C. Medial-lateral loading D. Rotational loading

D. Rotational loading - In place activities: Spin jumps - Dynamic distance drills: Lateral hopping

This image is an example of what tissue specific loading using plyometrics? A. Shock absorption B. Deceleration C. Medial-lateral loading D. Rotational loading

A. Shock absorption/ Deceleration - Depth jumping (jump downs)

This image is an example of what tissue specific loading using plyometrics? A. Shock absorption/ Deceleration B. Medial-lateral loading C. Rotational loading D. All of the above

A. Shock absorption/ Deceleration - In place activities: Cycle jumps, five-dot drill Depth jumping preparation: Jump-downs

This image is an example of what tissue specific loading using plyometrics? A. Shock absorption/ Deceleration B. Medial-lateral loading C. Rotational loading D. All of the above

A. Chops