TX midterms topics

Arthrogenic & Periarticular Contracture

- Caused by joints & irreversible - Stretching can solve this

Contracture

- More severe than just tightness - More extensive/permanent damage - Can be relieved through surgery

Frequency

- Number of stretching sessions per day or per week

Speed

- Speed of initial application of the stretch force

Circuit

- a series of exercise activities

Myostatic (Myogenic) Contracture

- actual

Full Range

- perceived Normative value of the movement - Accepted value

Sets

- pre-determined number of repetitions grouped together - after each ___ of a specified number of repetitions, there is a brief interval of rest

Initiation of Motion

- the actual action of the motion

Adaptation

- will adapt to the training stimulus over time - significant changes can be measured in a minimum of 10-12 weeks - results in increased efficiency of the cardiovascular system ans active muscles - dependent on ability of organism to change and training stimulus threshold

Pseudomyostatic (Apparent) contracture

- with an underlying cause

Circuit-interval

- with rest, different modes of exercise is done

Interval

- with rest, same modes of exercise is done

More than 10,000 kcal per day

Athletes engaged in intense training can use ______ kcal per day

-alignment - stabilization - Intensity - Duration - speed - frequency - mode

Determinants of stretching interventions

Straining

Muscle tightness it can cause ______

AVAILABLE RANGES PERIODICALLY

To maintain normal ROM segments must be moved through their _______

Exercise heart rate = HRrest + __ - __ % (HRmax - HRrest)

What is the karvonen's formula

40-60%

Percent For weak, elderly

80-90%

Percent for advanced clients or athletes

60-70%

Percent for normal, beginners

- ROM is usually not done when motion is disruptive to the healing process - Carefully controlled motion within the limits of pain- free motion during early phases of healing has shown to benefit healing and early recovery - Signs of too much or the wrong motion include increased pain and inflammation - ROM should not be done when the px response or condition is life-threatening - PROM may be carefully initiated to major joints and AROM to ankles and feet to minimize venous stasis and thrombus formation - AROM of UE and limited walking are usually tolerated under careful monitoring of symptoms after: o Myocardial infarction (heart attack) o Coronary artery bypass surgery (CABG) o Percutaneous transluminal coronary angioplasty

Precaution & Contraindications to ROMEs

- Use extra caution in px with known or suspected osteoporosis d/t disease, prolonged bed rest, age, prolonged use of steroids - Avoid vigorous stretching of muscles & connective tissues that have been immobilized for an extended period of time o Prolonged hold period can decrease the amount of reps/sets - Progress the dosage of stretching interventions gradually to minimize soft tissue trauma & post- exercise muscle soreness o Intensity o Duration o Frequency - Avoid stretching edematous tissue - Avoid overstretching weak muscles o Gets pulled by much stronger muscles

Precautions for Stretching

- Manual - Equipment - Wand or T-bar - a stick a px holds with both affected & unaffected side - Finger ladder, wall climbing, ball rolling - Pulleys - Skate board/ Powder board - Reciprocal Exercise devices - Heel slides -Wall slides -Shoulder wheel

Things to use for Self-Assisted ROM techniques

To maintain whatever the px can manage comfortably and to avoid deterioration due to disuse

What is the main goal of ROM?

End range

What should be reach AT ALL TIMES during evaluation of ROM?

45 mins

When the intensity is below the heart rare threshold, __ mins

- To maintain joint and soft tissue extensibility - To minimize loss of tissues flexibility and contracture formation

Why is ROM activities administered?

10 to 15 mins exercise periods are adequate

With hight- intensity exercise, __ to __ mins

20 - 30 mins

__ to __ min session is optimal at 60% to 70% MHR

Three 5 mins daily period

____ are effective in some deconditioned patients

Tilt table

used for px in prolonged recumbent (lying) position ▪ for px with orthostatic hypotension ▪ used to mimic a standing position in full ROM

Cool-down period

•The purpose of the_______ is to: •Prevent pooling of the blood in the extremities •Prevent fainting by increasing the return of blood to the heart and brain as cardiac output and venous return decreases. •Enhance the recovery period with the oxidation of metabolic waste and replacement of the energy stores. •Prevent myocardial ischemia, arrhythmias, or other cardiovascular complications. •Total-body exercises such as calisthenics and static stretching are appropriate. •The period should last 5 to 10 minutes.

Warm-up period

•To enhance the numerous adjustments that must take place before physical activity. • should be gradual and sufficient to increase muscle and core temperature without causing fatigue or reducing energy stores. •Characteristics of the period include: -A 10-minute period of total body movement exercises, such as calisthenics, and walking slowly. -Attaining a heart rate that is within 20 beats/min of the target heart rate

Range of Motion (ROM)

- A basic technique used for the examination of movement and for initiating movement into a program of therapeutic intervention

Exercise program

- A carefully planned ______ can result in: + Higher levels of fitness for the healthy individual + slow the decrease in functional capacity of the elderly + Recondition those who have been ill or have chronic disease.

Stretching

- A general term used to describe any therapeutic maneuver designed to increase the extensibility of soft tissues

ballistic stretching

- A rapid, forceful intermittent stretch - A high-speed & high-intensity stretch o Full-range o Seldomly used; uncommon in the PH - usually used in sports

Cyclic Stretching

- A relatively short-duration stretch force that is repeatedly but gradually applied, released, and then reapplied

Overstretching

- A stretch well beyond the normal length of muscle and ROM of a joint & the surrounding soft tissues, resulting in hypermobility

Fitness

- A term used to describe the ability to perform physical work. - Requires cardiovascular functioning, muscular strength and endurance, and musculoskeletal flexibility - based on direct or indirect measurement of the body's maximal oxygen consumption - oxygen consumption influenced by age, gender, heredity, inactivity, and disease - Estimation of maximal oxygen consumption

Active-Assistive ROM (AAROMEs)

- A type of AROM in which assistance is provided manually or mechanically by an outside force because the prime mover muscles need assistance to complete the motion - Px is still doing the motion voluntarily but they just need further external force assistance because their muscles are too weak to complete the motion on their own - PT aids when px starts to struggle in achieving their available ROM

Dynamic flexibility

- Active mobility or active ROM - The degree to which an active muscle cxn moves a body segment through the available ROM of a joint

Contracture

- Adaptive shortening of the muscle-tendon unit and other soft tissues that cross or surround a joint that results in significant resistance to passive or active stretch and limitation of ROM o Same restriction regardless of AROM or PROM

Physical activity

- Any bodily movement produces by the contraction of skeletal muscles that result in a substantial increase over resting energy expenditure.

Aerobic Exercise training (conditioning)

- Augmentation of the energy capacity of the muscle by means of an exercise program. - Training is dependent on exercise of sufficient intensity, duration, and frequency - FIT - FITT - Training produces cardiovascular and/or muscular adaptation and is reflected in an individual's endurance

Reversibility principle

- Detraining occurs rapidly when a person stops exercising. - After only 2 weeks of detraining, significant reductions in work capacity can be measured, and improvements can be lost within several months.

Fibrotic Contracture

- Fibrotic - Muscle tightness

Stabilization

- Fixation of one site of attachment of the muscle as the stretch force is applied to the other bony attachment

Mode

- Form or manner in which the stretch force is applied o Static o Ballistic o Cyclic - Degree of px participation o Passive o Assisted o Active - The source of the stretch force o Manual o Mechanical o Self

Duration

- Length of time the stretch force is applied during a stretch cycle - The shorter the duration of a single stretch cycle, the greater the number of repetitions applied during a stretching session

Intensity

- Magnitude of the stretch force applied o Low-intensity stretching (coupled with a long duration of stretch) results in optimal rates of improvement in ROM

static stretching

- Method of stretching in which soft tissues are elongated just past the point of tissue resistance & then held in the lengthened position with a sustained stretch force over a period time

Frequency

- Optimal frequency of training is generally three to four times a week.

Intensity

- Overload is stress on an organism that is greater than that regularly encountered during everyday life. -- The exercise load (overload) must be above the training stimulus threshold (the stimulus that elicits a training or conditioning response) for adaptation to occur. -- Once adaptation to a given load has taken place, the training intensity (exercise load) must be increased for the individual to achieve further improvement. --The higher the initial level of fitness, the greater the intensity of exercise needed to elicit a change.

Passive ROM (PROMEs)

- PT does all the work

Active ROM (AROMEs)

- PT instructs the px on what to do

Passive flexibility

- Passive mobility or passive ROM - The degree to which a joint can be passively moved through the available ROM

Continuous Passive Motion (CPM)

- Passive motion performed by a mechanical device that moves a joint slowly and continuously through a controlled ROM

Exercise

- Planned and structured physical activity designed to improve or maintain physical fitness

Alignment

- Positioning a limb or the body such that the stretch force is directed to the appropriate muscle group

Selective stretching

- Process whereby the overall function of a px may be improved by applying stretching techniques selectively to some muscles & joints but allowing limitation of motion to develop in other muscles or joints

Hypomobility

- Refers to decreased mobility or restricted motion - Caused by adaptive shortening of soft tissues can occur as the result of many disorders or situations - Any factor that limits mobility, causes decreased extensibility of soft tissues - May also impair muscular performance - Can lead to functional limitations & disability in a person's life

Manual Muscle Testing (MMT)

- Tests the muscle grade (strength)

Aerobic exercise period

- The ______ is the conditioning part of the exercise program. - The exercise period must be within the person's tolerance, above the threshold level for adaptation to occur, and below the level of exercise that evokes clinical symptoms.

Flexibility

- The ability to move a single joint or series of joints smoothly & easily through an unrestricted, pain-free ROM

Endurance

- The ability to work for prolonged periods of time and the ability to resist fatigue - Muscular endurance - Cardiovascular endurance

Type

- The exercise must involve large muscle groups that are activated in a rhythmic, aerobic nature.

Time ( duration)

- The greater the intensity of the exercise, the shorter the duration needed for adaptation; and the lower the intensity of exercise, the longer the duration needed.

Active ROM (AROMEs)

- The movement of a segment within the unrestricted ROM (available ROM) that is produced by active contraction of the muscles crossing that joint

Passive ROM (PROMEs)

- The movement of a segment within the unrestricted ROM (available ROM) that is produced entirely by an external force - There is little to or no voluntary muscle contraction - Done by either the PT or a slow-moving machine

Goniometry

- Used to measure the ROM in terms of degrees - Fulcrum - Distal/Proximal Arm

Ankle pumps

- alternating dorsi/plantar flexion

Resistance training program

- amount of resistance imposed ob the contracting muscle during each repetitions of an exercise - The intensity of resistance exercises is usually expressed in pounds (lbs) except for elastic exercises like thera-bands and thera-tubes

Hold

- amount of time of a sustained contraction or stretch - often followed by a brief break/rest after each repetition

Limitation of Motion

- anything that is between the px normal ROM

Exercise prescription

- brings about a change in personal health behavior to include habitual physical activity

Energy expenditure

- energy is expended by individuals engaging in physical activity and is often expressed in kilocalories - activities can be categorized as light, moderater, or heavy by determining the energy cost - it is the amount of heat necessary to raise 1kg of water 1 degree celsius - it is equal to approximately 3.5 mL/kg per minute

Exercise parameters

- enhances physical fitness - promotes health by reducing risk factors for chronic disease - ensures safety during exercise participation

Progression

- increase in activity during exercise training that stimulated adaptation - increases in any of the components of the exercises as tolerated by the individual

Specificity principle

- individual improves in the exercise task used for training and may not improve in other tasks.

Kilocalorie

- is a measure expressing the energy value of food

Time/duration

- length of an exercise session - expressed as minutes per session

Maximal Oxygen Consumption (VO2max)

- measure of body's capacity to use oxygen - expressed in mL/kg/min

Myocardial Oxygen consumption

- measure of oxygen consume by the myocardial muscle

Type

- mode of exercise - form of exercise and type of muscle contraction that occurs

Continuous

- no rest with intensity not lower than THR

Repetition

- number of tines a particular movement is repeated - number of muscle contractions performed to move the limb through a series of continuous or complete excursions against a specific exercise - usually 10 reps 3 sets

Deconditioning

- occurs with prolonged bed rest - effects of deconditioning are seen in the patients who had extended, acute illness or long-term chronic condition

Gross Motion Evaluation

- px examination without the use of a goniometer

Examination of Movement

- px history ans chief complaints

Self-Assisted ROM techniques

- px positioning is important with exercises that are stagnant and non-moving

Frequency

- relatively physiologic difficulty of the exercise - more commonly applicable in aerobic exercises and resistance exercises - introduces a challenge to the Px - difficulty of exercise

Stress testing

- serves as a basis for determining exercise levels or the exercise prescription

End Range

- the end if the px available ROM

Irreversible Contracture

- warrant a surgery

Available Range

- what the px can manage to reach - anything that is beyond this ROM is considered as stretching

1800 to 3000 kcal per day

Average individual engaged in normal daily task expends ______ to ______

- A bony block limits a joint motion - There was a recent fracture & a bony union is incomplete - There is evidence of an acute inflammatory or infectious process or soft tissue healing could be disrupted in the tight tissues & surrounding region o For fractures, stretching a not fully healed injury can cause a re-fracture - There is sharp, acute pain with joint movement or muscle elongation - A hematoma or other indication of tissue trauma is observed - Hypermobility already exists - Shortened soft tissues provide necessary joint stability in lieu of normal structural stability or neuromuscular control - Shortened soft tissues enable a px with paralysis or sever muscle weakness to perform specific functional skills otherwise not possible

Contraindication to Stretching

1. Muscle mass 2. Strength 3. Cardiovascular function 4. Total blood volume 5. Plasma volume 6. Orthostatic tolerance 7. Exercise tolerance 8. Bone mineral density

Deconditioning decrease in:

- Gravity - A machine - another individual - Another part of the individual's own body

External force may be from:

- Prolonged immobilization of a body segment - Sedentary lifestyle - Postural malalignment & muscle imbalances - Impaired muscle performance - Tissue trauma resulting in inflammation & pain - Congenital or acquired deformities

Factors for Restricted Motion: Hypomobility

15 secs x 10 reps x 1 set 30 sec x 3 reps x 1 set

Full parameter for stretching

10 reps 3 sets

Full parameters for ROME

- Do not passively force a joint beyond its normal ROM

General precaution for stretching

- Maintain physiological elasticity and contractility of the participating muscles - Provide sensory feedback from the contracting muscles - Provide a stimulus for bone and joint tissue integrity - Increase circulation and prevent thrombus formation o Thrombus - a blood clot stuck in one place o Embolus - clot that floats through the blood stream - Develops coordination and motor skills for functional activities

Goals of AROME

- To decrease the complications that would occur with immobilization - Maintain joint and connective tissue mobility - Minimize the effects of the formation of contractures o There is still a possibility of voluntary muscle contraction - Maintain mechanical elasticity of muscle o Stretches but returns back to normal - Assists in the circulation and vascular dynamics o Presence of blood flow - Enhance synovial movement for cartilage nutrition and diffusion of materials in the joint o Promotes joint lubrication - Decrease or inhibit pain - Assists with the healing process after injury or surgery - Help maintain the px awareness of movement o px awareness of limb motion without seeing it

Goals of PROME

requires 7.5 to 9.9 kcal/min, or 23.0 to 30.6 mL

Heavy work for average male

= 220 - age (in years)

How to determine the maximum heart rate (HRmax)

- ROM is limited because soft tissues have lost their extensibility - Restricted motion may lead to structural (anatomical) deformities that are otherwise preventable - There is muscle weakness & shortening of opposing tissue - May be used as part of a total fitness program designed to prevent musculoskeletal injuries - May be used prior to & after vigorous exercise potentially to minimize post-exercise muscle soreness

Indication for use of stretching

- Whenever a px is able to contract the muscles actively and move a segment with or without assistance - When a px has weak musculature and is unable to move a joint through the desired range of A-AROM is used - AROM can be used for aerobic conditioning programs - When a segment of a body is immobilized for a period of time o AROM is used on the regions above and below the immobilized

Indication of AROME & AAROME

- In the region where there is acute, inflamed tissue, passive motion is beneficial o Any form of active muscle contraction can worsen the inflammation present - When a px is not able to or not supposed to actively move a segment/s of the body

Indication of PROME

- Manual or Mechanical/Passive or Assistive Stretching - Self-stretching - Neuromuscular Facilitation & Inhibition Techniques - Muscle Energy Techniques - Joint, Soft Tissue or Neural Tissue Mobilization/Manipulation

Interventions to increase mobility of soft tissues

requires 2.0 to 4.9 kcal/min, or 6.1 to 15.2 mL O2/kg per minute, or 1.6 to 3.9 METs

Light work for the average male

➢ Active ROM does not maintain or increase strength ➢ Does not develop skill or coordination except in the movement patterns used ➢ Does not increase ROM

Limitation if AROME

- True passive, relaxed ROM may be difficult to obtain when muscle is innervated and the px is conscious Passive motion DOES NOT: ➢ Prevent muscle atrophy (decrease in muscle size) o delays it instead ➢ Increase in strength or endurance ➢ Assist in circulation to the extent that active, voluntary muscle contraction does ➢ Increase ROM o only maintains ROM to avoid deterioration

Limitation of PROME

1. Transport of oxygen 2. oxygen biding capacity of the blood 3. Cardia function 4. Oxygen extraction capabilities 5. Muscular oxidative potential

Maximal oxygen consumption is dependent on:

1. Heart rate 2. Systemic blood pressure 3. Myocardial contractility 4. Afterload

Myocardial oxygen consumption is determined by: