unit 4 for 220
what are active and active assist range of motion limitations
-does not maintain or increase strength -does not develop skill or coordination expect in the movement patterns used
explain the stress strain curve in steps.
1. With an externally applied load, collagen fibers elongate quickly as wavy fibers align and straigten.2. With increased loading, tension increases and the fibers stiffen.3. Continued loading will progressively increase fiber strain until a point where bonds between collagen fibers begin to break.4. When a substantial number of bonds are broken, the fibers themselves will ultimately fail.5. Failure of collagen due to tensile loading occurs at less than 10% increase in fiber length, whereas elastin may lengthen 150% without failure.
what are the four goals of TE
1. remediate or prevent impairment of body functions and structures. 2.improve,restore, or enhance activities and participation 3. prevent or reduce health related risk factors 4. optimize overall health, fitness, or sense of well being
what is a selective stretching when dealing with hypo mobility
Allowing slight hypomobility to develop in the long flexors of the fingers while maintaining mobility of the wrist extensors enables the patient with spinal cord injury, who lacks innervation of the intrinsic finger muscles, to regain the ability to grasp by using a tenodesis action.
what are the sets/reps fro endurance
Involves performing many repetitions of an exercise against submaximal load.Light grade thera band.
LOOK AT BOX 4.5
LOOK AT BOX 4.5
what do you not need to do if it will interfere with the healing process
PROM and AROM
what is an example of cyclic stretching
PROM to the joint/muscle, when at the end point of PROM, stretch the patient for 5 seconds at their end point and continue for multiple reps
what three things occur to a muscle when immobilization in a shortened position for several weeks
Reduction in muscle length, Reduction in muscle fibers, Reduction in the number of sarcomeres
what is the expected outcome of stretching exercises
Restore or increase muscle-tendon unit extensibility to regain or achieve the flexibility and ROM required for functional activities.
what is the difference between stretching and ROM since they are not synonymous terms
Stretching takes soft tissue structures beyond their available length to increase ROM. ROM exercises stay within the limits of available tissue length to maintain mobility
Determine the recommended sets for strengthening exercise
Three sets of 10- RM performed for 10 repetitions over the period led to strength gains.
Where is it imperative to stabilize with elongation? Why?
To stabilize either the proximal or distal attachment site of the muscle-tendon unit being elongated. Without stabilization, the attachment sites are free to move with the tissue, reducing the ability to effectively maximize the origin-insertion distance.
give the underlying principle for stress relaxation
Used in prolonged stretching procedures in which the stretch position is maintained for several hours or days.
explain creep
When a gradually increasing external load is applied to a viscoelastic tissue and then sustained, the tissue will continue to slowly elongate during the maintained stretch This slow adaptation to sustained loading is a time-dependent property of a viscoelastic tissue. The amount of tissue deformation depends on the amount of force and the rate at which the force is applied. Low-magnitude loads reaching the elastic range and applied for long periods of time increase connective tissue deformation and allow gradual rearrangement of collagen fiber bonds (remodeling) and redistribution of water to surrounding tissues. Increasing the temperature of the tissue enhances creep and the extensibility of the tissue. Complete recovery from creep may occur over time, but not as rapidly as recovery from a short duration load.
explain the sliding filament theory
When a motor unit stimulates a muscle to contract, the actin- myosin filaments form connections called cross- bridges, slide relative to each other, and actively shorten the muscle. When a muscle relaxes, the myofilaments slide apart slightly, and the muscle returns to its resting length.
what does dynamic flexibly depend on
ability of a muscle to contract though the Rom and on the degree and quality of tissue extensibility
define mobility
ability of body structures or segments to move so that the ROM for functional activities is allowed (functional ROM) also defined as the ability of an individual to initate, control, or sustain activity movements of the body to perform motor task (functional ROM)
which stretch appears to lead to enhanced performance, especially with longer duration stretches (longer than 90 seconds)
acute dynamic
which stretch has either no effect or decreases muscle performance (strength, power, or endurance) immediately filling the stretch session
acute static
what type of stretches appear to lead to enhance performance
acute static, acute dynamic, dynamic stretching, chronic stretching
what is a contracture
adaptive shortening of the muscle-tendon unit and other soft tissues that cross or surround a joint, resulting in significant resistance to passive or active stretch and limited ROM. can compromise functional abilities. contracture- almost complete loss of motion shortness- partial loss tightness- restricted motion due to adaptive shorting of soft tissue muscle tightness- adaptive shortening of the contractile and non contractile elects of muscle
explain how effects of age can change collagen in the stress strain curve
aging decreases maximum tensile strength and stiffness of tissue, and the rate of adaptation to loading is slow
Identify the two constant factors for any exercise designed to improve muscle performance.
alignement and stabilization
positioning a limb or the body such that the stretch force is directed to the appropriate muscle group.
alignment
what are the determinate of stretching interventions
alignment, stabilization, intestate of stretch, duration of stretch, speed of stretch, frequency of strech, mode of stretch
what is strain on the stress strain curve
amount of deformation or lengthening when an external force is applied (the point where lengthening is being impacted by the strain).
when injured muscles are immobilized, type 1 muscle fibers
atrophy at a faster rate than type 2 fibers
the ability to align body segments against gravity to maintain or move the body within the available BOS without falling. example- standing on one leg, quadruped wile lining opposite arm and leg
balance
which muscles do you want to workout before
big muscles first then little ones. hight intensity excercises before lower
associated with repetitive dynamic motor activities such as walking, cycling, swimming or upper extremity ergometry
cardiopulmonary endurance
the ability to perform moderate-intensity, repetitive, total body movements over an extended period of time. example- running on a treadmill, cycling
cardiopulmonary endurance
which stretch is performed as part of a comprehensive conditioning program on a regular basis over a period of weeks not only increases flexibility, but also appears to have beneficial effects on physical performance
chronic stretching
___- is 5x as string as ____
collage - elastin
which connective tissue Is responsible for strength and tensions of the tissue. as they develop they will bond with unstable hydrogen and the stronger they are the greater the stability is
collagen fibers
since tendons orientation are of collagen fibers and the typical tensile loading pattern, how are these collagen fibers arranged and and what can they resist
collagen fibers are parallel and can resist the greatest tensile load. Their fiber alignment is in series with muscle fibers to transmit muscle forces to the bone.
what is skins orientation of collagen fibers and the typical tensile loading pattern
collagen fibers have a random orientation and so are limited in resisting higher levels of tension
what are the three types of connective tissue
collagenous, elastic, reticular
resistance to a force applied in a manner that approximates tissue. (Weight bearing through a joint will produce this stresses)
compression
refers to a form of dynamic muscle activation in which tension develops and physical shortening of the muscle occurs as an external resistance is overcome by internal force, as when lifting a weight
concentric
____ muscle contractions accelerate body segments whereas ______ contractions decelerate body segments
concentric- eccentric
the correct timing and sequence of muscle firing combined with the appropriate intensity of muscular contraction leading to the effective initiation, guiding, and grading of movement. basis of smooth accurate, effeicnet movement and occurs at a conscious or automatic level
coordination
explain how effects of corticosteroid can change collagen in the stress strain curve
corticosteroids use has a long-lasting deleterious effect on the mechanical properties of collagen with a subsequent decrease in tensile strength.
explain how effects of injury can change collagen in the stress strain curve
damaged tissue follows a predictable healing pattern , with newly synthesized type 3 collagen bridging the injury site. This collagen is structurally weaker than mature type 1 collagen.
what is the primary cause of restricted mobility in all individuals
decreased extensibility of connective tissue
list the components that must interact to affect soft tissue responses and outcomes
direction, velocity, intensity , duration, frequency of the stretch force, tissue temperature, tissue tension, tissue stiffness. mechanical characteristics of contractile and noncontracile soft tissue and neurophysiological properties of contractile tissue affect tissue lengthing
Define self stretching. What is the recommended duration?
done independently by the patient after careful instruction and supervised practice. This enables patients to maintain or increase the extensibility gained as the result of a direct intervention by a therapist. (Hold for 30-60sec per rep.)
ength of time the stretch force is applied during a stretch cycle. (how long)
duration of stretch
form of flexibility. It is the extent to which an active muscle contraction can rotate a joint through its available ROM.
dynamic flexibility (active mobility or active ROM )
which strech is a controlled movement throughout the active ROM for each joint
dynamic stretching
involves dynamic muscle activation and tension production that is below the level of external resistance se that physical lengthening of the muscle occurs as it controls the load, as when lowering a weight
eccentric
what are the six effects that can change collagen in the stress strain curve
effects of immobilization, inactivity, age, corticosteroid,injury, other conditions affecting collagen
stretched soft tissue that returns to its pre stretched resting length directly after a short-duration stretch force is removed.
elastic
which connective tissues provide extensibility. Show a great deal of elongation with small loads and fail abruptly without deformation at higher loads. Allow the tissue to be stretched. (Greater flexibility)
elastin fibers
who is ballistic stretching not okay with
elderly or sedentary individuals or patients with musculoskeletal pathology or chronic contractures.
ability to perform low intensity, repetitive or sustained activities over a prolonged period of time
endurance
characterized by 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
endurance training
what does passive flexibility depend on
extensibility of soft tissue that crosses and surrounds a joint
the ability to move freely, without restrictions used interchangeably with mobility
flexibility
the ability to rotate a single joint or series of joints smoothly and easily through an unrestricted, pain free, ROM.
flexibility
through research, name the two stretching procedures that have been shown to improve _____ and increase _____ 1. ______ 2.___
flexibility and increase ROM. 1. static stretching 2. PNF stretching
what is stress on the stress strain curve
force (or load) per unit area
number of stretching sessions per day or week.
frequency of stretch
what is a skateboard/ power board used for self assisted
friction free surface to encourage movement t without resistance of gravity or friction. ABD/ADD of hip spine or horizontal ABD/ADD of shoulder sitting
define ROM
full motion possible when soft tissue pass over the joints affecting the amount of motion that can occur between any two bones
how is mobility related to functional mobility and functional ROM
functional mobility- associated with both joint integrity and soft tissue flexibility. sift tissues that cross or surround joints must have sufficient extensibility to allow an individual to perform their functional tasks and activities
what should the therapist always keep in mind while selective stretching
functional needs of the pt and the importance of maintaining a balance between mobility and stability for max functional performance
the ability of the neuromuscular system to produce, reduce or control forces, contemplated or imposed during functional activities in a smooth coordinated manner
functional strength
Explain the SAID principle
guise to determine specific parameters for patient growth..concept to improve a specific muscle performance element, the resistance program should be matched to that element constructs. Suggests that a framework of specificity is necessary foundations on which exercise programs should be built.
deduced fucntional motion often caused by adaptive shortening or decreased extensibility in soft tissue
hypo mobility
explain how effects of immobilization can change collagen in the stress strain curve
immobilization causes collagen turnover and weak bonding between the new, nonstressed fibers, resulting in decreased stiffness.
describe Pseudomyostatic contracture and the TE interventions
impaired mobility and limited ROM, muscle spams, guarding, pain. involved muscle appear or be in a constant state of contractions giving rise to excessive resistance to passive strict TE intervention- neuromuscular inhibition procedures reduce muscle tension temp. are applied, full, passive elongation of the apparently shortened muscle is then possible
what is imperative to the individual with stretching and why
imperative that the individual use any newly gained range to allow the remodeling of tissue and to train the muscle control the new range. Without functional use of the newly gained range, the tissue may gradually return to its shortened length.
what is PROM inidcations
indications- region where there is acute, inflamed, passive motion, when a pt is not able to or not supposed to actively move a segment of the body. indication after surgical repair of contractile tissue when active motion would compromise the repaired muscle
magnitude of the stretch force applied.
intensity of stretch
why is an overhead pulley significant in self assist ROM
is utilizes more muscle activity than therapist AROM and continuous passive motion machines. PRECAUTION- easily misused resulting in compression of the humerus against the acromin process and can lead to increase pain and decrease function.
early controlled motion is okay as long as
it does not disrupt the healing process and pt can handle the exercise.
skilled manual therapy interventions specifically applied to joint structures by the clinician to modulate pain and treat joint impairments that limit ROM.
joint mobilization
functional activities that are antigravity will require assistance when the muscle test grades
less than 3/5
what kind os stretch applied to chronic contractures take advantage of creep
long duration
what is a rest interval for high exercise intensity
longer rest break. 3+ after each set
Regarding intensity of stretch, what is the ideal?
low intesnity
What are the goals of PROM
maintain joint and connective tissue mobility, minimize the effects of the formation of contractures, maintain mechanical elasticity of muscles, assist circulation and vascular dynamics, enhance syndical movement
examples of stabilization for stretching are
manual contacts, straps or belts, body weight, a firm surface
a type of active-resistive exercise in which resistance is provided by a therapist or other health professional. used in the early stages of an exercise program when the muscle to be strengthen is weak and can overcome only min to mod resistncace
manual resistance exercise
direct hands on intervention by a practitioner
manual stretching
what are forms of self assisted ROM
manual, Equipment, wand or T-bar, Finger ladder, wall climbing, ball rolling, pulleys, skateboard/power board, reciprocal exercise devices.
an end range stretch force will elongate shortened muscle tendon units and/or periarticalr connective tissue when a restricted joint is rotated just beyond its available ROM the force is applied manual contact or mechanical device, static or cyclic
manual/mechanical passive or assisted
a form of active-resistive exercise in which resistance is applied through the use of equipment or mechanical apparatus. used when The amount of resistance necessary is greater than what the therapist can apply manually.
mechanical resistance
a device used when manual therapies have been ineffective
mechanical stretching
the ability of structures or segment of the body to move or be moved in order to allow the occurrence of range of motion for functional activities.
mobility
form or manner in which the stretch force is applied (static, ballistic, or cyclic), degree of patient participation (passive, assisted, or active), or the source of the stretch force (manual, mechanical, or self).
mode of stretch
What is PROM
movement of a segment within the unrestricted ROM that is produced entirely by an external force
the ability of a muscle to contract repeatedly against a load, generate and sustain tension and resist fatigue over an extended period of time
muscle endurance
manipulative procedures that evolved out of osteopathic medicine designed to lengthen muscle and fascia and mobilize joints. employ voluntary muscle contractions by the patient in a precisely controlled direction and intensity against a counterforce applied by a practitioner (contract- relax)
muscle energy
what interact to determine flexibility
muscle length, joint integrity, and periarticular soft tissue extensibility
capacity of the muscle to produce tension and do physical work (power-output) using a cuff weight during an exercise
muscle performance
the capacity of a muscle to do work (force X distance). Is a complex component of functional movement and is influenced by all of the body systems.
muscle performance
what are the interrelated components of physical function
muscle performance, balance/postural equilibrium, stability, neuromuscular control/coordination, cardiopulmonary endurance, mobility/flexibility
another aspect of muscle performance is related to the strength and speed of movement and is defined as the work (force x distance) produced by a muscle per unit of time (force x distance / time)
muscle power
the major sensory organ of muscle and is sensitive to quick and sustained (tonic) stretch. The main function is to detect and convey info about muscle length changes and the velocity of those changes.
muscle spindle
refers to the ability of contractile tissue to produce tension and a resultant force based on the demands placed on the muscle
muscle strength
Describe a myostatic contracture and the TE interventions
musculotendinous unit has adaptively shortened and there is a significant loss of ROM, there is no specific muscle pathology present. reduction in numbers if sacromer units in series. TE intervention- stretching exercises
interaction of the sensory and motor sensory that enables synergist, agonists, and antagonist, as well as stabilizers and neutralizers, to anticipate or respond to proprioceptive and kinesthetic information. example- pt working on single stance balance
neuromuscular control
explain how effects of other conditions affecting collage can change collagen in the stress strain curve
nutritional deficiencies, hormonal imbalances, and dialysis may predispose connective tissue to injury at lower levels of loading than normal.
describe fibrotic contractures and irreversible contracture
occurs after long periods of immobility with tissues in a shortened position or after tissue trauma and the subsequent inflammatory response. fibrous changes in connective tissue of muscle and periarticular structures can cause adherence to tissues and subsequent development of a fibrotic contracture. the longer it exists the more difficult it becomes to regain optimal mobility and the more likely the contracture will become irreversible
Effective stretching requires maximizing the distance b/t what two thing
origin and insertion
what is a CPM
pasive motion performed by a mechanical device that moves a joint slowly and continuously through a controlled ROM
form of flexibility It is the extent to which a joint can be passively rotated through its available ROM
passive flexibility (passive mobility or PROM)
____ is paramount when working with a patient
patient saftey
For therapeutic efficiency, how should exercise be performed in regards to position
perform all motions possible in one position and then change the pts position and perform all appropriate motions in that position, progressing the treatment with minimal Turing of the patient
the tendency of soft tissue to assume a new and greater length after a stretch force is removed. (Ability of muscle)
plasticity
used interchangeably with static or dynamic balance
postural control, postural stability, equilibrium
what is PROM limitations
prevent muscle atrophy, increase strength and endurance, assist circulation to the extent that active, voluntary muscle contraction does
what are mechanical stretching devices used for
prevention and treatment of joint contractures of the extremities with the goal to maintain or restore ROM to the joint
list benefits attributed to stretching exercises
prevention/reduced risk of soft tissue injuries, reduced post exercises muscle soreness, and enhance physical performance
______ and ______ must be incorporated when a PTA is treating a patient to minimize his/her own risk of injury
proper body mechanics and pts instructions
why is reciprocal exercise devices useful for self assisted ROM
provides flexion and extension to an involved extremity using the strength of the normal extremity. bcycle, erogmeter
define muscle range
related to functional excursion of muscles. the distance that a muscle is capable of shortening after it has been elongated to its maximum
mechanical stretching devices apply a very low-intensity stretch force over a prolonged period of time to create
relatively permanent lengthening of soft tissues, presumably due to plastic deformation.
any form of active exercise in which a dynamic or static muscle contraction is resisted by an outside force applied manually or mechanically.
resistance exercise
describe Arthrogenic and periarticular contracture and the TE interventions
results of intra-articular pathology. may include adhesions, synovial proliferation, joint effusion, irregulariest in articular cartilage or osteophyte formation. TE- restricting normal arthokinematic motion
which connective tissue provide tissue with bulk
reticulin fibers
a process by whereby the overall function of a patient may be improved by applying stretching techniques to some muscles and joints while allowing motion limitations to develop in other muscles or joints.
selective stretching
Any stretching exercise that is carried out independently by a patient after instruction and supervision by a therapist. forces are applied by the pt at the end of available rom fro the purpose of elongating hypomobile soft tissues
self stretching
performed independently by a patient after careful instructions and close supervision
self stretching
resistance to two or more forces that are applied in opposing directions. (can have this on the joints, avoid this from sheets.)
shear stress
what is a rest interval for low intensity
short rest break, just a pause
do not attempt to gain full range in 1-2 treatment sessions since resolving mobility impairments is a
slow gradual process and may take several weeks of stretching to see significant results
esigned to improve the extensibility of any soft tissue that limits mobility. Involves application of specific and progressive manual forces using sustained manual pressure or slow, deep stroking. (friction massage, myofascial release, trigger point therapy)
soft tissue mob/maipulation
rate of initial application of the stretch force.
speed of stretch
ability of the neuromuscular system, through synergist muscles, to hold a proximal or distal segment of the body in a stationary position or to control a stable base throughout superimposed movement
stability
fixation of a bony segment that has an attachment of the muscle to be stretched.
stabilization
what terms are associated with long duration stretch
static, sustained, maintained, prolonged
the development of muscle strength is an integral component of most rehabilitation or conditioning programs for individuals of all ages and all ability levels
strength training
when a quick or sustained stretch force is applied to a muscle-tendon unit, the primary and secondary afferents of intrafusal muscle fibers sense these length changes. increase or facilitation of active tension in the muscle being stretched
stretch reflex
A general term used to describe any therapeutic maneuver designed to increase soft tissue extensibility with the intent of improving flexibility and ROM by elongating (lengthening) structures that have adaptively shortened and have become hypomobile.
stretching
what techniques are designed to increase tissue extensibility and joint mobility
stretching, Paula/mechanical stretching, passive/assisted stretching, self stretching, muscle energy, joint mob, soft tissue mob/manipulation
what is therapeutic exercise
systemic, planned performance of physical movements, postures, or activities intended to provide a patient/client
the resistance to a force applied in a manner that will lengthen the tissue. A stretching force results this
tension
what are the three types of stress
tension, compression, shearing
what Is the ultimate goal of a TE program
the achievement of an optimal level of symptom free movement during basic to complex physical activities
what is manual assistance for self assisted ROM
the patient can be taught to use the uninvolved extremity to move the involved. can be done supine, sitting, or standing.
Muscle can adapt to prolonged positioning in shortening or lengthening states. Is this a permanent adaptation? If not, what is the time frame before it resumes its pre-immobilization use and function?
three to five weeks
when transitioning from PROM and AROM vary patient position
to use gravity to either assist or resist the motion
although stretching is often throughout of as as warm up activity performed prior to vigorous exercise, an appropriate warm up is
typically through low intensity active exercise and is carried out in preparation for stretching. warming up prior to stretching is an important element of rehabilitation and fitness programs
what is ligaments, joint capsules, and fascia, orientation of collagen fibers and the typical tensile loading pattern
varies so that they can resist multidirectional forces. Ligaments that resist major joint stresses have a more parallel orientation of collagen fibers and a larger cross sectional area.
A time-dependent property of soft tissue. It resists deformation such as a change in length, when a stretch force is applied but will slowly lengthen if the force is sustained. gradually return to its prestretch configuration after the stretch force is removed
viscoelasticity
define joint range
what happens at the joint (flexion, extension, abduction, adduction, and rotation) measure with goni
what is active insufficiency and give examples
when a 2 joint muscle is too short to produce much tension. example- when you flex your elbow, flex your wrist, and then try to ball your hand into a fist. the flexor muscle become insufficient
when is a wand/Tband used
when a pt has voluntary muscle control in an uninvolved upper extremity but needs guidance or motivation to complete the ROM in the shoulder or elbow to provide assiatcne
what is the passive insufficiency and give examples
when it is fully lengthened and lifts motion at one of the joints it crosses. example- short hamstring. when you cannot bend down and touch your toes that is because your hamstrings can not stretch enough and therefore become insufficient
what does wall climbing provide for the pt
(finger ladder) provides pt with objective reinforcement and therefore motivation for performing shoulder ROM
list the signs and symptoms of delayed onset muscle soreness
- Muscle soreness and aching beginning 12-24 hrs after exercise, peaking at 48-72 hrs, and subsiding 2 to 3 later. - Tenderness with palpation throughout the involved muscle belly or at the myotendinous junction -Increased soreness with passive lengthening or active contraction of the involved muscle -Local edema and warmth -Muscle stiffness reflected by spontaneous muscle shortening before the onset of pain -Decreased muscle strength prior to onset of muscle soreness that persists for up to 1 to weeks after soreness has remitted
list factors that influence patient safety during exercise
- a pts prior health history -medications -medical clearance from physican -accuracy to which exercises are performed -well maintained equipment -a pt is unaccustomed to exercise -informed a pt of signs of fatigue and the relationship to risk of injury
list the types of TE interventions
- aerobic conditioning and recondition -muscle performance exercises: strenght, power, and endurance training - stretching techniques including muscle lengthening procedures and joint mobilization/manipulation techniques - neuromuscular control, inhibition, and facilitation techniques and poster awareness training -postural control, body mechanics and stabilization exercies -balance exercises and agility training -relaxtaion exercises -breathing exercises and ventilatory muscle training - task specific functional training
list ways the PTA should prepare for exercise instructions
- pt education, show them how, why, and how it will help them in there goals - have to go in with a plan, and present that pan with a positive attitude - collaborative relationship and all the patient to have an input on their goals - know pts. learning style and pay attention to their attitude towards exercises -answer to yourself does the pt believe exercise will lessen symptoms or improve function, is the pt concerned that exercising will be uncomfortable, accustomed to managing in regular exercise
Determine the appropriate frequency for strengthening
-Frequency is dependent on the pts. goals , general health status, previous participation in an exercise program, and response to training. -Frequency of 2-3 times per week is common. Rest interval of 48 hours when training major muscle groups can be achieved by exercising the upper extremities one day and the lower on the next.
why is low intensity ideal
-More comfortable for the patient -Minimizes voluntary or involuntary muscle guarding -Enables pt to remain relaxed, or assist if they need
list guidelines for teaching self assisted ROM
-educate the patient on the value of the motion -provide drawings and clear guidelines for numbers of receptions and frequency -teach the pt correct body alignment and stabilization -observe pt performance and correct any substitute or unsafe motions -if equipment is used, be sure all hazards are eliminated for application to be safe
what are active and active assist goals
-maintain physiological elasticity and contractility of the participating muscles - provide sensory feedback from the contracting muscles -provide stimulus fo bone and joint tissue integrity -increase circulation and print thrombus formation -develop coordination and motor skills for functional activities
what are active and active assist indications
-when a pt. is able to contract the muscle actively and move a segment with/without assistance - when a pt has weak musculature and is unable to move a joint through a desired motion -when a segment of the body is mobilized for a period of time -AROM can be used for aerobic condition programs and is used to receive stress from sustained postures
explain what is happening against gravity, gravity eliminated, and gravity assist and how a position should be providing assistance for patients
-when going against gravity, it may be necessary to provide assistance to the pt. -if you are in a gravity minimized position, the part may need only to be supported while the muscles take the apart through the range. -when the part moves down, with gravity causing the motion, muscle antagonist to the motion become active and may need assistance in controlling the descent
name and characterize the determine of a resistance exercise program
1. Alignment of segments of the body during exercise 2. Stabilization of proximal or distal joints to prevent substitutions 3. Intensity the exercise load 4. Volume: the total number of repetitions and sets in an exercise sessions 5, Exercise order: the sequence in which muscle groups are exercised during an exercise session. Work larger muscles then work smaller muscles* 6. Frequency : the number of exercise sessions per day or per week 7. Rest interval : time alloted for recuperation between sets and sessions of exercise 8. Duration : total time frame of a resistance training program 9. Mode : a type of muscle contraction, position of the patient, form of resistance, arc of movement, or the primary energy system utilized 10. Velocity of exercise 11. Periodization : variation of intensity and volume during specific periods of resistance training 12. Integration of exercise that approximate or replicated functional demands
recognize the signs and symptoms of muscle fatigue (why aren't they progressing)
1. An uncomfortable sensation in the muscle, even pain and cramping 2. Tremulousness in the contracting muscle 3. An unintentional slowing of movement with successive repetitions of an exercise 4.Active movements: jerky, not smooth 5. Inability to complete the movement pattern through the full range of available motion during dynamic exercise against the same level of resistance 6.Use of substitute motions - that is, incorrect movement patterns- to complete the movement pattern 7. Inability to continue low- intensity physical activity 8.Decline in peak torque during isokinetic training
list the steps performed after stretching
1. Apply cold to the soft tissues that have been stretched and allow these structures that have been stretched out to cool in a lengthened position. Cold may minimize poststretch muscle soreness that can occur as the result of microtrauma during stretching. When soft tissues are cooled in a lengthened position, increases in ROM are more readily maintained. 2. Regardless of the type of stretching intervention used, have the patient perform active ROM and strengthening exercises through the gained range immediately after stretching. With your supervision and feedback, have the patient use the gained range by performing simulated functional movement patterns that are part of daily living, occupational, or recreational tasks. 3. Strengthen the antagonistic muscles in the newly gained range to ensure adequate neuromuscular control and stability as flexibility increases.
provide strategies to foster adherence to an exercise program
1. Explore and try to appreciate the patients beliefs about exercising or the value the patient places on exercising as a means to "get better" 2.Help the patient identify personal beliefs derived from adhering to the exercise program. 3. Explain the rationale and importance of each exercise and functional activity. Ex. transverse abdominis; keeping core tight during normal daily activities while pt. is standing at the stove. 4.Identify how specific exercises are designed to meet specific patient- centered goals or functional outcomes. 5. Allow and encourage the patient to have input into the nature and scope of the exercise program, the selection and scheduling of practice and feedback, and decisions of when and to what extent exercises are progressively made more difficult to enhance a patient's sense of self control. 6.Keep the exercise program as brief as possible 7.Identify practical and functionally oriented ways to do selected exercises during everyday tasks. 8. Have the patient keep an exercise log 9. If possible, schedule follow-up visit(s) to review or modify exercises. 10. Point out specific exercise-related progress 11. Identify barriers to adherence; then suggest solutions or modify the exercise program.
List when eccentric exercises are appropriate
1. Following musculoskeletal injury or surgery 2. In conditioning programs to reduce the risk of injury or reinjury associated with activities that involve high intensity deceleration, quick changes of direction, or repetitive eccentric muscle contractions.
list potential factors that lead to hypo mobility
1. Prolonged immobilization of a body segment 2.Sedentary lifestyle 3.Postural malalignment with muscle length alterations 4.Imparied muscle performance (weakness) associated with musculoskeletal or neuromuscular disorders 5.Tissue trauma resulting in inflammation and pain 6.Congenital or acquired deformities
what are the steps to prepare for stretching
1. Review goals and desired outcomes of the stretching program with the patient. Obtain consent to initiate tx. 2.Select the stretching techniques that will be most effective and efficient. 3.Warm up the soft tissues to be stretched by the application of local heat or by active, low-intensity exercises. Warming up tight structures may increase the extensibility and decrease the risk of injury. 4. Have the patient assume a comfortable, stable position that allows correct plane of motion for the stretching procedure. 5. Explain the procedure to the patient and be sure that he or she understands. 6. Free the area to be stretched of any restrictive clothing, bandages, or orthotics. 7. Explain to the patient that it is important to be as relaxed as possible and that the stretching procedures are meant to remain within his or her tolerance level.
Name three reasons why a patient might be immobilized in a lengthened position for a prolonged period of time?
1. Surgical procedure, post-op problem (limb lengthening) 2. Application of a series of cast. Limb lengthening 3. The use of a dynamic orthosis to stretch a long-standing contracture and increase ROM.
both _____ and ____ tissues have ___ and ____ quality while only _____ have ____ properties
1. contractures 2. noncontracture 3. elastic 4. plastic 5. non contractile connective tissues 6. viscoelastic
resistance is applied in ______ to that of a limb movement to resist a _____ muscle contraction and in the _____ as limb movement to resist an _____ contraction
1. direction opposite 2. concentric 3. same direction 4. eccentric
ROM needed to perform functional activity _____ necessarily mean ___ or _____ ROM
1. does not 2. full 3. normal
if the tightness is on the _____ side of the _____/_____ ______ it is called a ______ contracture
1. flexion 2. flexion/extension joint 3. flexion
___ is a stretch well beyond the normal length of ___ and ___ of a joint and the surrounding _____ _____ results in ________
1. overstretching 2 muscle 3 ROM 4. soft tissue 5. hypermobility
list nine practical suggestions fro effective exercise instructions
1. select a non distracting environment 2. initially teach exercise that replicate movement patterns of simple functional task 3. demonstrate proper performance of an exercise, talk them through it, and then have the pt model the movements, correct them after you've seen them perform 4. guide the pt through the movement 5. use clear and concise verbal and written instructions 6. complement written instructions for a home exercise program with pictures of the exercise 7. have pt demonstrate an exercise to you as you supervise and give feedback 8. provide specific action related feedback and a why. 9. teach an entire exercise program in small increments to allow time for a patient to practice and learn the comments of the program over several visits
a muscle immobilized in a ____ position atrophies and weaken at a ____ rate than a muscle immobilized in a _____ state (arm sling)
1. shortened 2. faster 3. lengthened
list consideration a PTA must take into effect when developing/implememting an effective exercise interventiton
1. the therapist must understand how the many forms of exercise affect tissues of the body dn body systems and how those exercise induced effects have an impact on key aspects of physical function as they relate to the human movement system 2. Be able to integrate and apply knowledge of anatomy, physiology,Kinesiology pathology, and the behavioral sciences across continuum of patient/client management from the initial examination to discharge planning. 3. a therapist must understand the relationships among physical functioning, health, and disability and apply these conceptual relationships to patient/client management to facilitate the provision of effective and efficient health care services.
to develop TE programs that culminate positive/meaningful outcomes, a PTA must do what
1. understand the relationships among physical functioning, health, and disability and apply these conceptual relationships to patients to facilitate the provisions of effective and efficient health care services. 2. know and apply principles of motor learning and motor skill acquisition to exercise instructions and functional training
what are benefits of CPM
1.Prevents development of adhesions and contractures and thus joint stiffness 2. Provides a stimulating effect on the healing of tendons and ligaments 3. Enhances healing of incisions over the moving joint 4. Increases synovial fluid lubrication of the joint and thus increases the rate of intra-articular cartilage healing and regeneration 5. Prevents the degrading effects of immobilization 6. Provides a quicker return of ROM 7.Decreases postoperative pain
list the indications for stretching
1.ROM is limited because soft tissues have lost their extensibility as the result of adhesions, contractures, and scar tissue formation, causing activity limitations or participation restrictions. 2.Restricted motion may lead to structural deformities that are otherwise preventable. 3.Muscle weakness and shortening of opposing tissue have led to limited ROM. 4.May be a component of a total fitness or sport-specific conditioning program designed to prevent or reduce the risk of musculoskeletal injuries. 5 May be used prior to and after vigorous exercise.
name two methods to promote motivation when designing an exercise program
1.design an exercise program so the least complicated or stressful exercises are taught first and educate your patient on why your doing it. 2. ending an exercise session with a successful effort to help maintains a pts level of motivation
ROM activités are administer to _______ and ________ to minimize loss of ______ and _______)
1.maintain joint and 2.soft tissue mobility 3. tissue flexibility and 4.contracture formation
what is the recommended duration of a mechanical stretch
15-30 min to as long as 8-10 hours per sessions or continuous throughout the day
what is a rest interval for moderate intensity
2-3 minutes
What is the typical frequency for stretching?
2-5 sessions per week with time between sessions as needed for tissue healing and to minimize DOMS. Manual stretching duration: It is held for 15-60 seconds and repeated for at least several repetitions.
what are the sets/reps for power
20%- 70% of 1 -RM, while the rate of exercises should be explosive of ballistic. 1 set of 5. high load, low reps
explain the clinical tips for cold after stretching and when the most beneficial time to do it is and why
24-48 hours after injury to minimize swelling, muscle spams and pain. After stretching, cold should be applied to soft tissues held in a lengthened position to minimize post stretch muscle soreness and to promote longer-lasting gains in ROM.
what are the sets/reps fo strength
3 sets of 10.
what happens if healing and remodeling time is. not allowed and would you intensive stretching ?
A breakdown of tissue (failure) occurs as in overuse syndromes and stress fractures. Intensive stretching is usually not done everyday in order to allow time for healing. If the inflammation from the micro ruptures is excessive, additional scar tissue, which could become more restrictive, is laid down
What is the overload principle?
A foundational element that guides the use of resistance exercise in improving muscle performance. To improve a muscles performance a greater resistance load must be applied which will challenge the muscle. don't use the same size weights, use weights to gain/strenghten muscle
what is cycling stretching
A relatively short-duration stretch force that is repeatedly but gradually applied, released, and then reapplied multiple times during a single treatment session.
what is a grade 3 ligament injury related to stress strain curve
Complete rupture or tissue failure after deformation beyond the plastic range
What terms are associated with short duration stretch?
Cyclic Intermittent Ballistic
Identify the difference b/t external stabilization and internal stabilization.
External : can be applied manually by the therapist or sometimes by the patient with equipment internal- achieved by isometric contractions of an adjacent muscle group that does not enter into the movement pattern but holds the body segment of the proximal attachment of the muscle being strengthened firmly in place. only if muscle is strong and not fatigue
a sensory organ near the musculotendinous junctions of extrafusal muscle fibers. The function of is to monitor changes in tension of muscle- tendon units.
Golgi tendon organ
Give an example of selective stretching when dealing with a spinal cord injury that needs stability of the trunk for independence when sitting. With thoracic and cervical lesions, the patient does not have active control of the back extensors.
If the hamstrings are routinely stretched to improve or maintain their extensibility and moderate hypomobility is allowed to develop in the extensors of the low back, this enables a patient to to lean into the slightly shortened structures and have some degree of trunk stability for long-term sitting.
how can hyper mobility be detrimental to joint instability
If the static supporting structures and/or the dynamic muscular control for the joint are unable to maintain the joint in a stable, functional position during activities. Instability of a joint can cause pain and predispose a person to injury.
explain how effects of inactivity can change collagen in the stress strain curve
Inactivity decreases the size and amount of collagen fibers, resulting in weakening of the tissue.
what happens to a muscle when subjected to prolonged immobilization? what is the outcome and what is the increase in
It is not used during functional activities and the physical stresses placed on it are substantially diminished. Outcome: muscle atrophy and weakness Increase: in fibrous and fatty tissue in muscle
what is a grade 2 ligament injury related to stress strain curve
Macrofailure: rupture of an increased number of fibers and partial failure after deformation into the later part of the plastic range
Which type of stretching is most appropriate in the early stage of a stretching program?
Manual stretching may be most appropriate in the early stages of a stretching program when a therapist wants to determine how a patient responds to varying intensities or durations of stretch and when optimal stabilization is most critical (15-60 second holds)
what is a grade 1 ligament injury related to stress strain curve
Microfailure: rupture of some fibers after deformation into the early part of the plastic range
who is ballistic stretching OK
OKAY- prior athletic activities, general fitness or rehbabiltion programs with young, healthy subjects participating in a conditioning program
