BYU EXSC 602 Graduate AT Exam 1 Study

4 Step Problem Solving Process

1. Understand the problem

   1. need to look at whole problem (and sometimes BEYOND)

   2. Look beyond heuristics if it isn’t working. (can be helpful short term, test them and then put them away and test it all)

2. Devise a plan (Translate)

3. Carry out the Plan (Solve)

4. Look Back (Check and Interpret

Heuristics

Heuristics

• Anchoring

• Availability

• Representativeness

• using these is LAZY

Cognitive Biases

• Bandwagon Effect

• confirmation bias 

• framing effect 

• Over confidence

Foundation of Problem Solving

1. Think

2. Meaningful questions

3. Problem solving 

Novice clinician

• rigid adherence to taught rules

• little situational perception

• no discretionary judgement

Competent Clinicians

• sees actions in terms of long-terms or wide spread conceptual framework 

• follows standardized and routinised procedures 

• should be here AFTER BOC

Expert clinicians

• no longer relies explicitly on rules/guidelines

• has intuitive grasp on situations

• doesn’t let the expectations cloud the available data

• uses funnel approach 

• does not come from getting certified, takes lifetime of learning

PRO-ACT-IVE

Problem

Reframe the problem

Objectives

Alternatives

Consequences

Trade-offs

Integration of 

Values

Exploration 

REMEMBER (Problem Solving)

• don’t make assumptions

• have all data been considered?

• do all the data fit the problem?

• have you continued to collect data and make adjustments?

• keep differential diagnoses/treatments in mind don’t settle on your first thought

Training vs. Conditioning

10 principles of conditioning

1. warm up/cool down

2. motivation

3. overload

4. consistency

5. progression

6. intensity

7. specificity 

8. individuality 

9. minimize stress

10. safety 

SAID principle

Specific Adaptation to Imposed Demands

when is this applicable? 

Systems affected by Stress/Load

• enhance heart muscle

• increase the bone density

• calm the nervous system

• reduce the body weight

• fresh air is better for health

• boost the brain function

• strengthen the respiratory system

• raise the immunity

Warm-Up 

• injury prevention

• performance enhancement

• general and specific

• time period???

• temperature of muscle

  • blood flow

  • elasticity

  • nervous system - secret weapon, can manipulate to help us

    • pumps and channels are much more efficient

Cool Down

• Blood pooling following activity

  • important to get blood back centrally from peripheral 

  • clears debris from working muscle 

  • slows re-oxygenation

  • increases HR - stress on heart 

• Same activity as warm-up?

• combine with stretch

Flexibility/Stretching

• ROM possible around joint or series of joints

  • maybe get it through proposed activity and not necessarily stretching

  • warm up first can be helpful 

  • ROM can be limited due to injury and scar tissue on connective tissue

• injury prevention ?? - not really (in those with normal ROM, population is 50/50 that has less ROM) 

• Performance enhancement?? - not really 

Stretching Techniques

• Ballistic

  • bouncing (like a warm up) primes nervous system for activity 

• Static 

  • Holding tension 

• PNF

  • passive stretches with active muscle contractions 

** Ballistic and static have same effectiveness

Strength

• maximum force that can be applied by a muscle during a single contraction

• determines strength

  • size

  • neuromuscular efficiency

  • biomechanical factors

Strength Terms

Hypertrophy - increase size of muscle (fiber)

Atrophy - Decreased size of muscle (fiber)

Reversibility - if strength training is discontinued or interrupted, the muscle with atrophy

Length/Tension Relationship

optimal resting sacromere length is when the protein heads line up with each other (on sarcomere)

Types of muscle contraction

Isometric - generates force with changing length

Isokinetic - at a consistent speed

Plyometric - involves all 3 types of contractions

Isotonic 

• Concentric - shortening

• Eccentric - lengthening

Progressive Resistive Exercise 

work muscles against increasing resistance to build strength and size

Plyometric Training

power exercise 

uses stretch shortening cycle

high injury rate

cardiorespiratory fitness

ability of circulatory and respiratory systems to deliver oxygen to skeletal muscle during exercise

very important part of physical fitness

cardiovascular endurance is inversely related to cardiovascular disease

reduces relative risk of dying prematurely due to CVD

Cardiovascular Endurance

normative values based on VO2 max test

VO2 max indicates how well the heart and lungs work together to deliver oxygen and nutrients to working muscles and how well those muscles can utilize them

aerobic training adaptations

• type I fibers 7-22% increase

• capillary increase 5-15%

• fatty acid oxidation 30% increase

• VO2 improvement 15-20% 

• mitochondrial enzymes 2.5x more 

• mitochondria 15% more and 35% bigger

• myoglobin increase 75-80%

Grains Guideline

make ½ of your grains whole

women 19-30: 6oz 

men 19-30: 8oz

eat at least 3oz of whole grain

Vegetable guidelines

Vary your veggies

women 19-30: 2.5 cups

men 19-30: 3 cups

eat more dark green veggies, orange veggies, dry beans, and pasta

Fruit Guidelines

focus on fruits

2 cups for both men and women 19-30

eat variety (fresh, frozen, canned, dried)

go easy on fruit juices

Milk guidelines

get calcium-rich foods

men and women 19-30: 3 cups

go low fat or fat-free

if not milk, chose lactose free or other calcium sources

Meat and Beans Guidelines

Go lean on protein 

Women 19-30: 5.5oz

Men 19-30: 6.5oz 

choose low-fat or lean meats and poultry 

bake it, broil, or grill 

vary choices - fish, beans, peas, nuts, and seeds

Oil Guidelines

Know your fats

Women 19-30: 6 tsp

Men 19-30: 7 tsp

make most fat sources from fish, nuts, and vegetable oils

avoid butter, margarine, shortening and lard

general guidelines for eating healthy

Carbs 55-70% of caloric intake

Fat 20-25% of caloric intake

Protein 12-25% of daily caloric intake

needs depend on sport, level of training, and nutritional goals

Supplementation

Vitamins and minerals

• iron and calcium tend to be low (in females) 

• sodium and potassium can be replenished via sports drinks or diets

protein 

• daily needs usually exceeded in a normal diet 

performance - enhancing substances 

• creatine and caffeine 

Determining Protein Needs

0.8g/kg for average individual

1.1-1.4g/kg for recreational athletes

1.2-1.4 g/kg for endurance athletes

1.2-1.7g/kg for strength and power athletes

hydration guidelines

pre-exercise: 1.5-2.5 cups 2-3 hours before 

during exercise: 1 cup ever 15-20 min 

post exercise: 2-3 cups of fluid for every pound lost during exercise 

use sports drinks during if it exceeds an hour

Female Athlete Triad

• low energy availability

  • excessive reduction of dietary energy intake

  • excessive increase in energy expenditure

  • eating disorders are usually the first step in 

• menstrual disorders

  • when too little energy is available after exercise, a female athlete’s body reduces energy expenditure in other processes, in part by suppressing menstrual function 

• weak bone

  • when too little energy is available after exercise, the female athlete’s body also reduces energy expenditure by slowing the turnover of bone tissue

  • the loss of regular menstrual cycles often reduces the body’s production of estrogen, which normally restrains the rate of bone resorption 

Eating Disorders

affect both males and females and often strike during adolescence

8 million americans with eating disorder 

50% of americans know someone with an ED

10-15% of people with anorexia or bulemia are males

95% of people with ED are 15-25

18-20% of anorexics die within 20 yrs of contracting the disease

Healthy Eating

don’t restrict food servings below suggested guidelines of food guide pyramid

eat frequently, include healthy snacks between meals

establish a reasonable weight goal based on healthy body composition and a reasonable time to achieve the goal 

refer athlete for help in dealing with ED

Body Temp Affected by 

affected by

• metabolic heat production (ATP) 

• conductive heat exchange (needs contact) 

• convective heat exchange (though mediation)

• radiant heat (sun) 

• evaporative heat loss (sweat) 

  • increase blood flow to periphery 

  • water loss through sweat glands

  • water evaporates takes heat with it

Heat Illnesses

heat syncope

heat cramps

heat exhaustion

heat stroke

Heat Syncope

peripheral pooling of blood

symptoms: dizziness, fainting, and nausea 

tx: place in cool environment, lay down (feet up), replace fluids 

Heat Cramps

water loss / electrolyte osmotic imbalance

energy fuel depletion 

tx: hydrate and stretch 

Heat Exhaustion 

Causes: Hot, humid weather, outside temp of 90+* & humidity 70%+ = danger. prolonged sweating, inadequate fluid replacement 

Symptoms: sweat profusely, cold & clammy, pale face, excessive thirst, fatigue/weakness, mental dullness, weak, rapid pulse, shallow breathing

TX: treat for shock, ventilate area, remove excess clothes, increase fluid intake, sponge with ice water

Heat Stroke

Causes: hot humid weather, thermoregularity failure

Symptoms: no sweat, nausea & headache, flushed skin, hot & dry, temp 106-112*, strong & rapid pulse, increased respiration, chest pain, loss of consciousness 

TX: call 911, cool athlete in ice water 

Prevention of heat injury

hydration

acclimatization

identify susceptible athletes

monitor temperature and humidity 

ACSM Hydration Recommendations

Nutritionally balanced diet and maintain normal hydration in 24 hrs prior to event 

consume 500 ml of fluid 2hrs before event

consume enough fluid during the event to equal loss or to tolerance 

fluid should be cool and accessible 

activiti4es lasting 50 min or more - use sports drinks to help replace glycogen stores 

activities of an hour or more - include sodium to enhance fluid retention and prevent hyponatremia 

Acclimization

attain adequate fitness in cool environment before attempting to heat acclimatize

exercise at intensities >50% VO2max and gradually increase the duration and intensity of sessions during the 1st 2 weeks

perform the highest intensity workouts in morning and evening

monitor body weight to ensure proper hydration

monitor body temp

Identify Susceptible Athletes

age, alcohol use, creatine use, drug abuse, obesity, skin condition, previous heat illness

hypothermia

complicating factors:

uniforms, interval competition, moisture, hydration

physiological response:

body shuts down between 77-85*F

shivering - sympathetic response

Heat Index

DBT - dry bulb temp 

WBT - wet bulb temp 

• DBT - WBT = relative humidity 

GT - global temp 

WBGT - universal wet bulb globe temp 

• =0.1 x DBT + .07 + WBT + GT x 0.2

hyponytremia

loss of salts, presents similar to heat illness, need to check core temp 

Stress

Everything we need for adaptation 

Physiological responses: 

alarm - fight or flight 

resistance - body prepares for coping and directs stress to particular body site 

exhaustion - organ or organ system becomes diseased as a result of chronic stress 

 

Negative stress results in 

muscle tension, reduction of flexibility, problems in coordination, decrease in movement efficiency 

Integrated model of Physiological Response to Injury

Biopsyhosocial Model

Psychology of Loss

Kubler-Ross Model 

• denial 

• anger

• bargaining 

• depression 

• acceptance 

Psych / personality factors that may predispose the athlete to injury

low confidence / self esteem

tense, restless, nervous

anxiety

attention seeking

Burnout - causes/sign/symptoms

Long seasons

not enough breaks

constant negative feedback 

decreased performance levels

difficulty concentrating 

loss of appetite

difficulty falling asleep 

prone to sickness

restlessH

how to prevent burnout

reaction to injured athletes

DO - be calm, reassuring, allow venting of emotion, show empathy, encourage them to talk to you

DONT - pity them, tell them they are abnormal, be abrupt

give every injury a fair look

don’t be condescending

psychology of rehab

rapport, give a sense of cooperation, make the experience an educational process, build competitive confidence

psychology of returning to competition

small, progressive steps

mental training techniques

• meditation

• progressive relaxation

• imagery

it is up to them how they’ll go back mentally

reactions to injury and early reactions to rehab

anger, anxiety, apprehension, bitterness, confusion, depression, disappointment, dispiritedness, devastation, fear, frustration, helplessness, relief, resentment, shock

Reactions to Rehab

shift towards more positive emotion: enthusiasm and excitement

evidence of periodic episodes of: depression, frustration, sadness

reactions to return to participation

myriad of mixed positive and negative emotions:

apprehension, anticipation, anxiety, confidence, depression, encouragement, fear of reinjury, frustration, reinjury anxiety

Injury Process

Primary: tissue destruction directly associated with traumatic force; can’t change amount of initial damage

Secondary: occurs from cell death caused by a blockage of O2 supply; can assist to keep minimum damage to other tissues 

injury response cycle = pain - spasm - pain cycle 

(chemicals stimulates free N endings & cause pain which causes M spasm & triggers body’s protective mechanisms) 

Healing Process

Inflammatory / Acute phase

Fibroblastic / repair phase

Maturation / Remodeling phase

Signs of Inflammation

redness, swelling, pain, heat, loss of function

Acute inflammation

recognition of injury 

vascular changes (vasodilation and permeability)

activation of endothelial cells

migration of leukocytes (primarily neutrophils) through vessel wall

accumulation of leukocytes at injury site

activation of leukocytes

phagocytosis and removal of debris

monocyte/macrophage infiltration

signaling of regenerative response

acute phase vascular response

experiences immediate platelet plug (vasoconstriction 5-10 min) [ first thing that happens so that we don’t bleed out 

THEN histamine induced vasodilation 24-36 hours

Permeability happens because of capillary budding

Acute Phase Cellular response

Leukocyte (neutrophil) migration

• 1st to arrive, not big enough to make a difference that they are not specialized

monocytes mature into macrophages

• macrophages are very specific

• can tell difference between debris and live cells

• when doesn’t develop, turns into chronic inflammation

Acute phase chemical mediators

Cell-derived histamines and prostaglandins

goals of the acute phase

clean up the debris (from injury and pathogen) 

localize the injury/infection 

• isolate the site and make sure everything else around it is okay

Fibroblastic/repair phase

2 days - 6 weeks

2 parts

fibroplasia - scar tissue formation

capillary budding - “feeds” the scar tissue

regenerative tissues

do not repair

• liver

• nervous system

• muscle

repair phase - fibroplasia

break down fibrin clot 

replace fibrin clot with granulation tissue (with extracellular matrix) 

formation of scar tissue

random network of connective tissue 

tensile strength of matrix increases with the line of stress

capillary budding

factors that impede healing

extent of injury

edema 

hemorrhage

poor vascular supply

separation of tissue 

muscle spasm

atrophy 

corticosteroids

keloids and hypertrophic scars

infection 

humidity, climate, oxygen tension

health, age, and nutrition

Maturation / Remodeling phase

3 mo - 2 years

balance between blast/clast activity

rehab must focus on strengthening

organizes as it matures

type 1 fibers phase out as stress is introduced and type 3 influxes

we help control this stress as ATs

chronic inflammation

Load: time, tissue, what’s been done in the past

repeated trauma

macrophage proliferation (instead of neutrophil)

increase in prostaglandin and bradykinin activity

>1 month = subacute

months to years = chronic

itis vs. osis

itis = inflammation

osis = degeneration

improved healing

PRESSUES

Oncotic vs> Hydrostatic

POLICE

Prevention

Optimal

Loading

Ice

• vasoconstriction, less volume, blood flow slowed upstream 

Compression

• manipulates, goes to lymphatic system

Elevation