Ch. 6/9 Ther ex. codes,aquatic,resistance

Delayed Onset Muscle Soreness (DOMS)

A temporary muscle soreness and stiffness that occur 24 to 48 hours after performing unaccustomed eccentric muscle contractions and last for three to four days.

Which of the following is a Precaution to Aquatic therapy? A.Patients with uncontrolled seizures B.Patients with unstable angina C.Patients with skin infections D.Patients with ataxia

A.Patients with ataxia

When a person is standing in chest-deep water, the percentage of weight bearing is approximately what percentage of body weight? A)10% B)20% C)33% D)50%

C)33%

Which of the following statements about the physical properties of water is true? A.As the level of water immersion increases, the amount of weightbearing increases B.Body composition does not affect one's ability to float C.Drag is the cumulative effects of turbulence and fluid viscosity on an object in motion D.Increasing the velocity of movement decreases the resistance to motion

C.Drag is the cumulative effects of turbulence and fluid viscosity on an object in motion

The difference between strength and endurance training is

Intensity and reps

When aiming for moderate intensity exercise, how should the patient respond after the first 1-2 reps of attempting the exercise with the amount of resistance you have given them A.Very light to Light B.Light to somewhat hard C.Somewhat hard to Hard D.Hard to very Hard

Light to somewhat hard

97112

Neuromuscular re-education

Where is the center of buoyancy found within a body immersed in deep water?

Sternum

97542

Wheelchair Management

Power training

exercise that emphasizes strength and speed movement.

97116

gait training

Factors or power training

increase work a muscle can do or reduce the time that muscle has to produce a force.

Endurance training parameters

low intensity muscle contractions, large number of reps, prolonged period of time.

What happens in the first 4 weeks or a strength training program?

neural adaptation and muscle fiber size increases

Resistance exercise precautions

pt with Hx of CV disorders 30-40% 1RM for UE and 50-60% LE

Drag

s the cumulative effects of turbulence (faster movements) and fluid viscosity (resistance to flow)

How can power be expressed?

single burst of high intensity activity or repeated burst at a lower intensity.

Hydromechanics

Physical properties and characteristics of fluid in motion

Thermodynamics

Specific heat: amount of heat (energy, calories) needed to raise the temperature of 1 gram by 1 deg Celsius

Which of the following exercises would be most difficult to perform? Assume the pt is immersed to the xiphoid process for all of these exercises.

Starting with the hip flexed to 90˚ and knee extended, return to 0˚ hip extension with hydroboot

muscle strength

The most weight you can lift or the most force you can exert at one time. (RM)

In a resistance training program, the non-exercised limb can receive some strengthening benefit from the exercised limb is better known as the A.Overload Principle B.Reversibility Principle C.SAID Principle D.Transfer of Training Principle

Transfer of Training Principle

Temperature regulation

Water temp can penetrate to deeper tissues, inversely proportional to subcutaneous fat • Pts cannot maintain adequate core warmth during aquatic exercise at temps less than 25 deg C (77 deg F) • Exercise in water temps greater than 37 deg C (98.6 deg F) can be harmful if maintained at high intensities because hot water immersion increases CV Demand at rest and with activity; increased cardiac output

overload principle

a load that exceeds the metabolic capacity of a muscle, challenging the muscle to perform at a level greater than that to which it is accustomed.

Endurance

ability to perform low intensity, repetitive , or sustained activities over prolonged period of time.

contradictions of resistance exercise

acute inflammation

Resistance exercise precautions

at risk pts -CAD -MI -cerebrovascular disorders -HTN - neurosurgery -eye surgery -intervertebral disk pathology

Which of the following pieces of equipment is most often utilized to keep a patient buoyant while deep water walking? A.Belt B.Hand Paddles C.Hydrotone Boot D.Kickboard

belt

Specific adaptation to imposed demands (SAID) principle

body systems adapt over time to the stresses placed on them

Muscle Performance

capacity of muscle to produce tension and do physical work (forcexdistance)

What is the COB in posteriorly placed buoyancy?

cases the patient to lean forward anterior buoyancy

What does vertical that does not intersect with the COB ?

causes a rotational motion • Forces posterior to COB cause pt to lean forward; Forces anterior to COB cause pts to lean backward • Pt with LE amputation (BKA, AKA) will lean toward the residual limb when vertical • If a pt is bearing weight on the pool floor, both COB as well as COG are at play

What happens to the body Low levels of resistance ?

decreased joint force and less irritation to soft tissue.

Rate of temperature change

dependent upon mass and specific heat of the object (water is 4x as much as air)

Reversibility Principle

detraining reduction of muscle performance begins after two weeks of cessation of resistance training and continues till training effects are loss.

specificty of training

exercises incorporated in a program should mimic the anticipated function, mimic mode, velocity, limp position and movement pattern of exercise as well.

The temperature of the pool water should be higher for vigorous aerobic conditioning (> 80% HRR) compared to gait training, stretching, and strengthening interventions? A.True B.False

false

With a patient at neck level immersion for aquatic therapy interventions, the percentage of maximum heart rate at which the patient can work can be increased by 7-20 bpm. A.True B.False

false

phytological fracture

fragility fracture or a fracture of bone already weaken by disease.

DOMS Prevention and Treatment

gradually increase intensity and volume of training, include warm up and cool down activities, stretch muscles gently before and after strenuous exercise

endurance training

having a muscle contract and lift or lower a light load for many repetitions or sustain a muscle contraction for an extended period of time; muscles adapt to endurance training by increases in their oxidative and metabolic capacities, which allows for better delivery and use of oxygen

Which of the following is the best way to monitor exercise in the pool?

heart rate /borgs scale

contradictions of resistance exercise

if pain cannot be eliminated by reducing resistance

transfer of training/overflow/cross training effect

in contrast to SAID carry over training effects one variation of exercises or task to another also has been reported

What are endurance training results?

increased oxidative capacity and metabolic capacity

What happens when a pt. adds equipment to move their extremities through water?

increases drag

resistance exercise

is any form of active exercise in which dynamic or static muscles contractions is resisted by an outside force manually or mechanically

how do you reduce DOMs?

light high speed isokinetic concentric exercise estim cryotherapy post exercise massage hyperbaric chamber Vitamin C and E compression sleeves topical creams

97140

manual therapy

97124

massage

contradictions of resistance exercise

pain with restricted isometrics

risk factors for osteoporosis type I

post menopausal women

Fear of water

precaution to Aquatic therapy

Respiratory Disorders • Lung expansion is inhibited by hydrostatic pressurs and due to increased circulation to the trunk) • Maximal oxygen uptake is less in water compared to land

precaution to Aquatic therapy

Small Open Wounds and Line

precaution to Aquatic therapy

• Cardiac Dysfunction (angina, abnormal BP, heart disease, or comprised pumps)

precaution to Aquatic therapy

• Neurological Disorders ( ataxia, heat intolerant MS (keep temp below 91 deg), controlled epilepsy)

precaution to Aquatic therapy

risk factors of osteoporosis type II

prolonged immobilization or disuse, restricted weight bearing post sx or trauma, extend use of corticosteroid and immunodepressions

What happens to drag as the speed of movement increases?

resistance to motion increases

During unilateral manual resistace exercises will cause the patient to?

revolves in a circular motion.

contradictions of resistance exercise

severe cardiopulmonary disease

contradictions of resistance exercise

severe pain in joints, muscles with movements

Osteoporosis

skeletal disease characterized by reduced mineralization of the bone due to imbalance between bone resorption and formation as well as narrowing of bone shaft and widening of medullary canal.

Power

strength and speed movement (froceXdistance/time)

Resistance exercise precautions

substitute movements

stregnth training

systematic procedure of a muscle or muscle group lifting, lowering, or controlling heavy loads for a relative low number of reps or over a short period of time.

Muscle endurance

the ability of a muscle to contract repeatedly against a load/ resistance , generate and sustain tension, resistance fatigue over a period of time (postural muscles)

Functional Strength

the ability of the neuromuscular system to produce, reduce, or control forces, contemplated or imposed, during functional activities, in a smooth, coordinated manner

Overwork

the progressive deterioration of strength in muscles already weakened by non-progressive neuromuscular disease

Center of Buoyancy (COB)

the reference point of an immersed object on which vertical forces of fluid react in a predictable manner; located at the sternum

97530

therapeutic activities

97110

therapeutic exercise

The difference between strength and power training is A.Frequency B.Time C.Mode D.Warm up

time

Cardiopulmonary endurance

total body endurance is associated with repetitive, dynamic motor activities and involve the use of large muscles of the body

Buoyancy

upward force that works opposite of gravity

Temperature Transfer:

water conducts heat/cold 25x faster than air; this transfer increases with velocity (pts lose body temperature faster with movement than standing still)

• Strengthening: manual or self (with equipment); use of PNF patterns

• Buoyancy Assisted (BA)...slowing effects of buoyancy • Buoyancy Supported (BS)...horizontal movements while supported in supine • BA, BS use equipment • Buoyancy resisted, no equipment, motion is perpendicular to vertical forces to create drag (increased resistance) • Buoyancy superresisted BSR; increasing resistance with equipment

CV Response and Training Effect of Deep Water running/walking

• CV Response: in healthy individuals, may see lower elevation of HR, ventilation, and VO2 max compared to land exercise • During low intensity exercise, cardiac patients experience lower cardiovascular stresses; as intensity increases stresses are similar to levels experiences with land exercise • Training effect: Gains in VO2 max carryover from water to land • Cardiovascular training in water maintains leg strength and maximum oxygen consumption in healthy runners

Pool Care and Safety

• Cleaning at least 2x/week; check pH levels at least 2x/day • Slip resistance walking surfaces; remove barriers • Posted emergency procedures • Life preservers readily available; someone certified in CPR always available • Built in filtration and chlorination systems

Aerobic conditioning

• Deep water walking/running (feet do not touch the bottom of the pool)=most common vertical cardio exercise (alternatives include cross country motions and high knee marching) • Equipment needed is belt for buoyancy (no equipment increases intensity of the exercise); fins and boots add LE resistance more than the water itself • Precursor to midwater walking/running (underwater treadmill at 4‐6 ft) and land based walking/running (may need special socks to reduce impact; can add equipment to further increase resistance) • Swimming strokes may elicit higher HR, BP, and VO2 max responses to exercise than other aquatic activities

Temperature scale conversion formula

• To change from degrees Celsius to degrees Fahrenheit, you multiply by 9, then divide by 5, then add 32 • To change from degrees Fahrenheit to degrees Celsius, you subtract 32, multiply by 5, then divide by 9

Resistance exercise precautions

-safety -Valsalva Maneuver

Which of the following occurs within the first 30 days of starting a resistance exercise program? A.Muscle hypertrophy B.Decreased rate of nervous system firing C.Increased muscle fiber recruitment D.Decreased synchronization of nerve firing

.Increased muscle fiber recruitment

how long does it take to get rid of lactic acid form skeletal muscle and blood ?

1 hour

Generally, max immersion time for pts without cardiopulm issues?

20 mins try to start with 10 mins and gradually build

When performing low intensity exercise, how many reps should the patient complete before showing signs of fatigue? A.8-12 B.12-20 C.20-30 30-45

20-30

To prevent heat illness when working 80% of pt. MaxHR water temps should be?

22-26*C or72-79*F

Flexibility, strengthening, gait training, and relaxation performed in a pool are best between?

26 and 35 deg C (79‐95 deg F)

Ideal water temperature to maximize efficiency, increase stroke volume and decrease HR?

26-28*C or 79-82*F

Flexibility, strengthing,gait, and relaxation is best performed in a pool between what temperatures?

26-35 degrees C or 79-95 degrees F

Which of the following is the most common temperature range for non-aerobic aquatic exercises?

26-35˚C (79-95˚F)

What does the temperature of the water need to be at for patients with spasticity?

26‐35 deg C, 79‐95 deg F

Low intensity

30-40% 1RM 20-30 reps to fatigue 9-11 Borges

What temperature does the water need to be at for a patient with acute musculoskeletal injuries to increase relaxation, decrease spasm, and increase pain threshold?

33 deg C (91 deg F)

Which of the following temperatures would be most appropriate for a patient with an acute musculoskeletal injury to reduce pain and increase relaxation

33°C (91°F)

What does the temperature of the water need to be at for pts with RA?

36‐37 deg C, 96.5‐98.6 deg F

Moderate intensity

50-70% 1RM 12-20 reps 11-13 Borges

High intensity

70-80% 1RM 8-12 reps 13-15 Borges

how much do you lower max HR by when in water?

7‐20 bpm due to physiological changes that occur with neck level immersion

What is 30 degrees Celsius converted to Fahrenheit?

86

What is the CPT Code for Ther Ex?

97110

The CPT Code for Aquatic Therapy is

97113

What is the CPT Code for w/c mobility and management

97542

Which of the following is true regarding aquatic therapy equipment? A)Buoyancy equipment placed anteriorly will facilitate posterior movements of the trunk in the vertical position. B)Buoyancy equipment used for supine positioning is ideal to assist with stabilization needed for eccentric manual resistance exercises. C)Nonbuoyant equipment used underwater provides resistance opposite the direction of movement. D)Using equipment to increase the surface area of an extremity underwater decreases resistance.

A)Buoyancy equipment placed anteriorly will facilitate posterior movements of the trunk in the vertical position.

Which of the following statements is true regarding the temperature range of water (26°C-35°C) recommended for aquatic exercise? A)Patients should perform cardiovascular exercise at the low end of this range. B)Patients with multiple sclerosis should exercise in temperatures at the high end of this range. C)Patients should perform intense aerobic exercise at the high end of this range. D)If a patient has an acute, painful injury, perform exercise at the low end of this range.

A)Patients should perform cardiovascular exercise at the low end of this range.

After a musculoskeletal injury of the lower extremity, you develop an aquatic exercise program for your patient. An aquatic exercise program is the least effective for: A)Transfer of training to land-based functional activities. B)Reducing risk of re-injury during the early stage of rehabilitation. C)Enabling early weight bearing. D)Increasing range of motion.

A)Transfer of training to land-based functional activities.

What procedure could a PTA apply during ROM if a pt c/o joint instability during rhythmic initiation?

A.Approximation to the joint throughout the ROM

Which of the following pieces of equipment can be used for dynamic stabilization training? A.Body Blade B.Elliptical Machine C.Mini trampoline D.Upper body ergometer

A.Body Blade

In which of the following conditions would the pt have the least amount of weightbearing? Assume pt has buoyancy support, if needed A.Deep water walking with pt immersed to the neck B.Deep water walking with pt immersed to the xiphoid process C.Water walking with the pt immersed to the hip D.Walking on land

A.Deep water walking with pt immersed to the neck

For a patient performing sidelying hip abduction, which of the following is true? A.Hip abductors work concentrically to lift, eccentrically to lower B.Hip abductors work concentrically to lift, hip adductors work concentrically to lower C.Hip adductors work concentrically to lift, eccentrically to lower D.Hip abductors work eccentrically to lift, concentrically to lower

A.Hip abductors work concentrically to lift, eccentrically to lower

Which of the following PNF techniques is defined as "a techniques by which the PT or PTA applies manual resistance in all planes, one at a time, which the patient holds the body part steady against the resistance."

A.Rhythmic Stabilization

Exercise induced muscle soreness

Acute muscle soreness(fatigue) develops during or directly after exercise performed to exhaustion possibly due to transient ischemia, build up of metabolites, waste products.

Decreasing the amount of weight bearing by immersing more of a person's body in water is a result of what property of water? A)Viscosity B)Buoyancy C)Surface tension D)Hydrostatic pressure

B)Buoyancy

In an aquatic environment, manual resistance exercises of the extremities typically involve which type of muscle contractions? A)Eccentric, closed-chain (distal segment fixed) B)Concentric, closed-chain (distal segment fixed) C)Isometric D)Concentric, open-chain (distal segment moving)

B)Concentric, closed-chain (distal segment fixed)

Increasing the amount of resistance to limb movement in water can be achieved by: A)Increasing agitation, moving the limb closer to the surface of the water, moving the limb quickly. B)Moving the limb further from the surface of the water, moving the limb quickly, and using a device to increase the effective limb volume. C)Decreasing water temperature, moving the limb further from the surface of the water, slowing limb movement. D)Moving the limb quickly, increasing water temperature, agitating the water.

B)Moving the limb further from the surface of the water, moving the limb quickly, and using a device to increase the effective limb volume.

A 55-year old man with stable congestive heart failure is unable to tolerate land-based exercises for strengthening his back because of chronic low back pain. He has expressed concern with attempting pool therapy because of his inability to swim and his use of pain medications. Which of the following statements is true about his ability to participate in aquatic therapy? A)Pool therapy is contraindicated because of the chronicity of his pain. B)Pool therapy can be used to decrease pain, improve mobility, and strengthen muscles. c)Fear of water and use of pain medications are a contraindication. D) Pool therapy is contraindicated for any individual with congestive heart failure.

B)Pool therapy can be used to decrease pain, improve mobility, and strengthen muscles.

. The typical duration of Aquatic therapy treatment is usually how long? A.10 minutes B.20 minutes C.30 minutes D.45 minutes

B.20 minutes

This physical property of water is defined as the force exerted by water on immersed objects. A.Buoyancy B.Hydrostatic Pressure C.Surface Tension D.Viscosity

B.Hydrostatic Pressure

Overtraining

Brought on by inadequate rest, too rapid of progression exercise, or inadequate diet and fluid intake and individuals fatigue quickly

While playing tennis, Mr. K sustained a grade 3 tear of the Achilles tendon and subsequently underwent a surgical repair of the tendon. His wound is now well healed, and he is permitted to immerse the incision site in water. His goal for therapy is to return to tennis competitively. To challenge his balance on the involved lower extremity, you have him stand in front of a strong, single stream of water (jet) while trying not to use his arms for balance. This activity applies which hydromechanics property of water? A)Drag B)Viscosity C)Laminar flow D)Turbulent flow

C) Laminar Flow

If present, which of the following conditions is a contraindication to having a patient perform an exercise program in an aquatic environment? A)Tracheotomy B)Fear of water C)Influenza D)High blood pressure

C)Influenza

The ability of the body to regulate temperature must be considered with the prescription of aquatic therapy for both the healthy and the rehabilitating patient. All of the following are true of temperature regulation except: A)The body is not as efficient at dissipating heat in the water as it is on land. B)Patients are unable to maintain adequate core warmth at water temperatures below 25°C. C)The ambient air temperature should be equal to the water temperature to avoid overheating or chilling while in the pool area. D)Water temperatures above 37°C cause increased cardiac demand both at rest and while exercising, especially with prolonged time or deep immersion.

C)The ambient air temperature should be equal to the water temperature to avoid overheating or chilling while in the pool area.

At the start of D1 flexion of the UE, in what position is the shoulder? A.Lateral rotation and abduction B.Medial rotation and abduction C.Lateral rotation and adduction D.Lateral rotation and abduction

C.Lateral rotation and adduction

. In moving into D2 extension, what motion is occurring at the wrist, hand, and forearm? A.Supination, wrist and finger flexion B.Supination, wrist and finger extension C.Pronation, wrist and finger flexion D.Pronation, wrist and finger extension

C.Pronation, wrist and finger flexion

Special equipment

Collars, rings, belts, and vests: assist with positioning by providing buoyancy (to trunk or extremity) • Swim bars: can support positioning of UEs or trunk in upright and LEs in supine, prone; can provide resistance for ther ex • Gloves, Hand Paddles: for UE resistance with movement; this equipment is not buoyant • Fins and Hydrotone Boots: for LE resistance with movement • Kickboards: Support upper trunk with bouyancy, create resistance with walking, challenge balance

The dynamics of circulation may be affected by immersing a body part in deep water due to the effects of: A)Viscosity. B)Laminar flow. C)Buoyancy. D) Hydrostatic pressure.

D) Hydrostatic pressure.

Which of the following is true of pools used for aquatic therapy? A)Ventilation is not necessary for installation of a self-contained, individual pool in your clinic. B)Therapeutic pools should not have a depth that exceeds 6 feet because of safety requirements in case of a medical emergency. C)One disadvantage of a self-contained individual pool is the inability to incorporate a treadmill. D)Built-in filtration systems are available in both therapeutic pools and self-contained pools.

D)Built-in filtration systems are available in both therapeutic pools and self-contained pools.

If a patient has lower extremity edema, which of the following principles associated with hydrotherapy (an aquatic environment) will assist with decreasing the edema? A)Viscosity B)Buoyancy C)Surface tension D)Hydrostatic pressure

D)Hydrostatic pressure

The difficulty of exercises can be controlled with the depth of immersion and the body's physiological response to hydrostatic pressure. According to Barbosa and colleagues, which of the following best describes a proper progression of a patient's exercise program in order to increase physiological demands? A)Fast repetitions while standing in chest-deep water B)Slow, controlled motions while standing in chest-deep water C)Fast repetitions, buoyancy-supported in a supine position D)Slow, controlled repetitions buoyancy-supported in supine position

D)Slow, controlled repetitions buoyancy-supported in supine position

Which of the following describes the most effective patient position and use of the buoyancy of water for self-stretching the hamstrings? A)In a buoyancy-supported supine position (flotation devices around the neck and hips), perform a unilateral straight-leg raise, lifting the leg to be stretched out of the water. B)With a buoyancy device secured around the distal thigh of the leg to be stretched, stand on the opposite leg and hold on to the side of the pool for balance. Keep the knee relaxed as the buoyancy device lifts the thigh and flexes the hip. C)Sit on the steps of a pool in waist-deep water, hips flexed to 90°, with a buoyancy device secured around the ankle of the leg to be stretched. D)With a buoyancy device secured around the ankle of the leg to be stretched, stand on the opposite leg and hold on to the side of the pool for balance. Allow the buoyancy device to lift the leg to the surface of the water with the knee extended.

D)With a buoyancy device secured around the ankle of the leg to be stretched, stand on the opposite leg and hold on to the side of the pool for balance. Allow the buoyancy device to lift the leg to the surface of the water with the knee extended.

What is the LE position at the end of D1 flexion? A.Hip Abduction and Lat Rot, Ankle PF and Eversion B.Hip Abd and Med Rot, Ankle DF and Ever C.Hip Add and Med Rot, Ankle PF and Inversion D.Hip Add, Lat Rot, Ankle DF and Inv

D.Hip Add, Lat Rot, Ankle DF and Inv

What is the position of the ankle at the start of D2 Extension? A.DF and Ever B.DF and Inv C.PF and Ever D.PF and Inv

D.PF and Inv

Which of the following is a component of proper resistance exercise technique? A.Movement of the joint/muscle through only the strongest part of the ROM B.1-2 second rest in between each repetition C.Excursion through the full, painfree, available ROM D.Independent with HEP, no need for v/c

Excursion through the full, painfree, available ROM

Stretching: manual or self (with equipment)

Exercise interventions

Purpose of Aquatic Therapy

Facilitate ROM, weightbearing activity, cardiovascular exercise • Initiate resistance training, functional activity replication • Provide 3 dimensional access to a patient • Enhance delivery of manual techniques, patient relaxation

laminar flow

Flows in parallel lines in a smooth progression

Viscosity

Friction occurring between molecules of liquid resulting in resistance to flow, which creates resistance with movement • Proportional to velocity of movement (so if you increase your velocity, you will feel increased resistance from the water) • Increasing the surface area moving through the water (such as level of immersion) will also increase resistance

. Which of the following interventions can be performed in the water?

Gait training Stretching Strengthening

Which of the following physiological changes is commonly seen with strength training?

Increased motor unit recruitment and firing

turbulent flow

Irregular flow with random variations in pressure.

Which of the following terms is defined as "diminished response to a repeated stimulus seen in the deterioration in the amplitude of the motor units firing"?

Muscle (local) fatigue