Adv. Therex Final

Are you sure

Power

• What is the equation for power?

• Measured in?

• What is power?

Treatment pyramid

• What is the load throughout (The order of what to do first in a session)

Power:

• Power = Force × Velocity OR Power = Work / Time

• Measured in Watts.

• Ability to exert force at a high velocity or any exercise incorporating velocity TREATMENT PYRAMID Load throughout: ROM/Flexibility → Strength → Power → Skill

Treatment pyramid:

• Load throughout: ROM/Flexibility → Strength → Power → Skill

Plyometrics:

• Coined by who and in what year?

• Plyo means?

• Metric means?

• Plyometrics mimic what activities?

• Which system is activated more: Nervous or Muscular?

• What are some benefits to plyometrics? (4)

• PLYOMETRICS

  • Coined by Fred Wilt in 1975.

  • Plyo = to increase.

  • Metric = measure.

  • Mimics sport activities.

  • Greater nervous system activation than muscular activation.

• BENEFITS

  • Increased jump height

  • Reduced sprint time

  • Improved running economy (the energy measured via oxygen consumption (VO₂) required to maintain a specific submaximal running speed)

  • Injury prevention

Stretch-shortening cycle SSC

• Mechanical model

  • SEC: What does it stand for and what does it do?

  • PEC: What does it stand for and what does it do?

  • What elements are active during concentric phase?

• Neurophysiological model

  • Stretch reflex increases what?

• What are the three phases the SSC?

• Mechanical Model:

  • SEC (series elastic component) stores energy like a spring (think of tendon)

  • PEC (parallel elastic component) provides structural support

  • Contractile elements active during concentric phase.

• Neurophysiological Model:

  • Stretch reflex increases muscle contraction.

• Phases:

  1. Eccentric – energy stored in SEC, muscle spindle activation as muscle lengthens

  2. Amortization – transition phase; shorter duration improves performance.

  3. Concentric – resultant power; SEC recoil + alpha motor neuron activation + voluntary contraction

Plyometric variables

• What are the three variables MRD? For one of the variables, why do we want to keep it quick?

Muscle fiber recruitment

• How can muscle fiber types be biased? Value for each 3 types?

• Plyometric variables:

  • Magnitude of stretch

  • Rate of stretch

  • Duration of stretch

    • Excessive duration causes heat loss and reduced stored energy.

• Muscle fiber recruitment: Muscle fiber type may be biased based on level of intensity:

  • <30% = Type I; slow twitch

  • 30–70% = Type IIa; fast twitch

  • >70% = Type IIb/x; fast twitch

Plyo Programming:

• Frequency: What factors may influence frequency (give some examples)? How many sessions a week? How many hours between session?

• Recovery: Dependent on what two things? If training fast twitch fibers, what is the work:rest ration? What is important to avoid excessive? How long is the program length?

• Plyometric volume: Volume is dependent on?

  • Plyometric foot contact recommendations based on intensity: Values for low, moderate, high, and very high?

  • Foot contact recommendations based on experience: Values for beginner, intermediate, and advance?

Programming

• Frequency:

  • Environmental factors may influence frequency (air pollution, heat, etc.)

  • 2–3 sessions/week

  • 48–72 hours between sessions

• Recovery:

  • Dependent on type and volume

  • If training fast twitch fibers (> 30% intensity) → Work:Rest ratio 1:5–1:10

  • Important to avoid excessive increase in respiratory rate

  • Program length 6–10 weeks

• Plyometric volume: Volume is dependent on intensity → The lower the intensity, the higher the volume

  • Low: 400

  • Moderate: 350

  • High: 300

  • Very High: 200

• Foot contact recommendations: Volume is dependent on experience →

  • Beginner: 80–100 contacts

  • Intermediate: 100–120 contacts

  • Advanced: 120–140 contacts

Quantifying plyometric volume

• For LE and UE

Lower extremity plyometrics may be expressed as total number of foot contacts or distance

• E.g. 3x10 reps = 30 hops

Upper extremity plyometrics may be expressed as total number of hand contacts or distance

• E.g. 3x15 reps = 45 ball bounces

Ground force reaction chart: For each of the following state what would cause increased GRF and decrease GRF

• Points of contact

• Speed

• Height of drill

• Weight

Variable	Increased GRF	Decreased GRF
Points of contact	Less contact surface (e.g., SL)	More contact surface (e.g., DL)
Speed	Greater speed	Slower speed
Height of the drill	Higher COM excursion	Lower COM excursion
Weight	Increased BMI or external load	Decreased BMI or external load

Lower Extremity Plyometric Nuances: Extensive vs intensive plyometrics

• Extensive vs Intensive:

  • Longer or shorter contact time?

  • Low or high intent?

  • Less or more neural demand?

  • Better for what phase of rehab?

  • Higher or lower GRF?

Extensive vs intensive plyometrics

• Extensive:

  • Longer contact time

  • Low to High intent

  • Less neural demand

  • Better for earlier phases of rehab

  • Lower GRF

• Intensive:

  • Short contact time

  • High intent

  • High neural demand

  • Better for later stages of rehab

  • Higher GRF

Sub-grouping plyometrics based on segments utilized

• Jumping and hooping will be defined by?

  • Jumping: What joint-biased? Single or double leg? Distance? A combination of a ________ with use of _____ yield a greater jump height (And give example for forward and one for backward jump)

  • Hopping: What joint-biased? Single or double leg?

  • Bounding: Describe the movement. What are the two patterns?

Sub-grouping plyometrics based on segments utilized: Jumping and hopping will be defined by the body segment doing the primary force

• Jumping

  • Knee-biased

  • Single-leg or double-leg

  • Greater distances

  • A combination of a countermovement with use of arms yields greater jump height

    • Forward arm swing during forward jump

    • Backward arm swing during backward jump

      

• Hopping

  • Ankle-biased

  • Single-leg or double-leg

• Bounding

  • Alternating single-leg movement

  • Sequential (alternate leg bound) or staggered patterns (skipping)

Ballistic drills

• Primarily eccentric or concentric? Give examples

• Velocity occurs in?

• Helpful to introduce before what training?

• What phase is omitted in ballistic drills?

• Primarily eccentric OR concentric

  • Ex: Concentric – Hang muscle clean, seated shot put

  • Eccentric – SL depth drop, falling push-up from knees

• Velocity occurs in one direction

• Helpful to introduce before plyometric training

• NO amortization phase

Speed

• What is speed? How is it different to velocity?

• What are the two sprint components?

• Determinants of speed is tied to what?

• Impulse: What is the equation? Referred to as area under?

• Speed

  • Distance covered per unit time (miles/hour; meters/second)

  • Does not include direction (unlike velocity)

• Sprint Components

  • Acceleration

  • Ability to maintain max speed

• Determinants of speed:

  • Rate of Force Development (RFD)

  • Slope at which the force is generated

    

• Impulse

  • Force × Time

  • Referred to as area under the force-time curve

• At the beginning of ground contact, the horizontal force is negative. That is the braking impulse because the force is acting backward against forward motion.

  After that, the horizontal force becomes positive. That is the propulsive impulse because the athlete is pushing backward into the ground to move forward.

Starting techniques:

• Hard starts (2)

• Soft starts (2)

Starting techniques

• Hard Starts:

  • Off blocks (Blocks you place your feet on before sprinting

  • 3-point stance (Stance you take before braking into a sprint)

• Soft Starts:

  • Falling start (Falling forward using the momentum to help you start sprinting)

  • Flying start (Starting at a light jog and working into the sprint)

Running as plyometrics

• How does it use the SSC? (Due to what motion of the body)

• What model?

• Jogging is considered low or high intensity plyo?

• Methods for improving speed

  • ______ practice

  • ______ training (This is the precursor to?)

  • What type of squats may be more specific to running

  • What direction exercises may have better carryover?

  • Use of what type of movements may have better carryover?

  • Mobility in what three muscle groups may lead to improved performance?

• Uses SSC due to vertical motion of body

• Spring-mass model

  

• Jogging = low-intensity plyometric

• Methods for improving speed

  • Sprinting practice

  • Strength training

    • Precursor to force

    • Partial depth squats may be more specific to running

• Horizontally driven exercises may have better carryover

• Use of explosive movements may have better carryover

• Mobility (hip flexors, quads, plantar flexor flexibility) → may lead to improved performance

Agility and COD

• COD

  • what does this stand for a mean?

  • Can be separated into what two subtypes?

• Agility

  • _______ change of direction in response to a stimulus

  • Requires what three things?

• Methods for improving agility:

  • ______ training (similar to speed training with greater emphasis on _______ training)

  • What drills? (2)

• Change of direction (COD)

  • Changing direction, velocity, or body segment position.

    • Can be separated into 2 subtypes: Cutting sports (court sports like basketball or tennis and field sports like soccer or football) or Other (gymnastics, wrestling, breakdancing, etc.)

• Agility

  • Reactive change of direction in response to a stimulus

  • Requires: Perception, Cognition, Reaction

    • COD = planned

    • Agility = reactive (Barry Sanders)

• Methods for improving agility:

  • Strength training (similar to speed training with greater emphasis on eccentric training)

  • COD drills

  • `Perceptual-cognitive drills

    • Addition of cognitive tasks to COD drills

    • Ex) Whistles, verbal commands, hand signals

Exercise Testing Study Guide

• What is it? What does it determine?

• Reasons for testing:

  • Assessment of?

  • Identifying what two things?

  • _____ setting

  • Evaluation of?

• Testing terminology

  • What is measurement?

  • What is units?

  • What are some types?

  • What are the three timing of testing?

• Reliability vs validity?

• Test selection consideration

  • What energy system

  • Biomechanical movement ______

  • ______ and ______ status

  • What two basic things to consider? (on like every survey or forum lol)

  • What factors?

• What is Exercise Testing: Any test/measure used to assess physical capacity. Determines starting point and readiness for exercise progression

• Reasons for Testing:

  • Assessment of athletic talent

  • Identify physical abilities and areas for improvement

  • Goal setting

  • Evaluation of progress

• Testing Terminology

  • Measurement = collecting data; seeks to quantify or describe an atttribute

  • Units: lbs, meters, seconds

  • Types: Laboratory tests, Field tests

  • Timing: Pre (Evaluation), Mid (Formative Evaluation), Post

• Reliability vs Validity

  • Reliability = Repeatability (regardless of accuracy)

  • Validity = Accuracy (bullseye)

• Test Selection Considerations

  • Metabolic energy system

  • Biomechanical movement specificity

  • Experience and training status

  • Age and sex

  • Environmental factors

Parameters of Athletic Performance

• Low speed strength: Example?

• High speed strength: What does it train and give an example.

• Anaerobic capacity: What is it (and lasting how many seconds) and give an example.

• Local muscular endurance: What is it? Approach failure without? Example?

• Aerobic capacity: Give some examples that test aerobic capacity (4)

• Change of direction: What are some examples that test COD? (3)

• Speed: Includes what two things? Assessed using what?

• Flexibility: Quadruped with ______ ______. What is a test that can be used to assess flexibility?

• Balance and stability

  • Balance = maintain what over what? Balance can be what two things?

  • Stability is? What system can be used to assess stability?

• Body composition: What tool can be used to measure this? Where should it be used? What are some other ways to assess body composition? (4)

• Anthropometry: What is it? Includes what three things?

• Low-speed strength

  • Sumo deadlift

• High-speed strength (power)

  • Ex) Vertical jump

• Anaerobic capacity

  • Max effort activity lasting 30-90 seconds

  • Ex) 300-yrd shuttle

• Local muscular endurance

  • Endurance test for selected muscle group, can last several seconds or minutes

  • Approach failure without loss of form or rest

  • Ex) Curl-up, push-up on knees, etc.

• Aerobic capacity

  • 1.5-mile run

  • 12-minute run

  • Yo-Yo Test

  • Maximal Aerobic Speed Test

• Change of direction

  • T-Test

  • 5-0-5 Agility Test

  • 5-10-5 Agility Test

• Speed

  • Includes acceleration and maximal speed

  • Assessed using a stopwatch

• Flexibility

  • Quadruped with thoracic rotation

  • Table-to-acromion test

• Balance and stability

  • Balance = maintain COM over BOS

    • Static and Dynamic balance

    • Y balance test for LE and UE

  • Stability = regain balance after disturbance

    • Balance Error Scoring System (BESS)

• Body composition

  • Skinfold caliper

    • Suprailium skinfold

  • Bioelectrical Impedance Analysis (BIA)

  • DEXA

  • Hydrostatic weighing

  • Air displacement plethysmography (BodPod)

• Anthropometry

  • Science of measurement

  • Includes: Height, Weight, + Body girth

Order of testing

• What are the 7 in order?

1. Non-fatiguing tests (anthropometric, flexibility, etc.)

2. Change-of-direction tests

3. Maximum power and strength tests

4. Sprint tests

5. Local muscular endurance tests

6. Anaerobic capacity tests

7. Aerobic capacity tests

Nothing Chases Me Sprinting Like An Arrow

CPT codes

• Timed (2)

• Untimed (2)

• Timed:

  • 97110 Therapeutic Exercise

  • 97750 Physical Performance Test or Measurement

• Untimed:

  • 97161 PT Evaluation Level 1

  • 97164 PT Re-evaluation

Defining Age

• What is biological age vs chronological vs training?

Sex and Gender

• What is Sex vs Gender?

Peak height velocity PHV

• What is it and when does it occur for females and males?

• Male peak muscle mass occurs how many years after PHV?

• Females peak muscle mass occur with more (and how is body fat affected after puberty)

Puberty

• Prepuberty: What are the training differences between males and females? What about height weight and body size?

• Post puberty females:

  • More _____ _____ less ______

  • How much relative strength compared to males (what fraction)

  • Less upper or lower body strength?

  • Less _____ (__% of males)

• Defining Age

  • Biological age: sexual maturation, pubertal development, skeletal age, muscular and hormonal development.

  • Chronological age: age based on date of birth (children grow at constant rate, substantial variability)

  • Training age: years participating in formal training.

• Sex vs Gender

  • Sex: biological classification (male or female) according to physical/physiological characteristics

  • Gender: socially constructed roles and self-identification

• Peak Height Velocity (PHV)

  • Age of maximum growth rate

    • Females ~12 years, males ~14 years.

  • Male peak muscle mass ~1.2 years after PHV.

  • Females peak muscle mass occurs with more variability (↑ body fat after puberty)

• Puberty

  • Pre-puberty: no major training differences biologically between males and females

    • No difference in height, weight, or body size

  • Post-puberty females:

    • More body fat and less muscle

    • 2/3 the relative strength compared to males

    • Less upper body strength

    • Less power (63% of males)

Sex-Based Training Considerations

Strength (Pre to post puberty)

• Males show

  • Significant increase in what joint and what motion?

  • Observed increase in what joint and what motion?

  • Observed increase in what joint (bilaterally) and what motion? What about for females?

• Females show lower normalized _____ and ______ peak torque. Compared to males: Quadriceps had a significant decrease of __-__% of peak torque. Hamstring had a significant decrease of __-__% of peak torque

Strength (pre- to post-puberty)

• Males showed:

  • Significant increases in R knee extensor strength

  • Observed increase in L knee extensor strength

  • Observed increase in B knee flexor strength

• Females show lower normalized quadriceps and hamstring peak torque.

  • Compared to the males:

    • Quadriceps had a significant decrease of 12-13% of peak torque.

    • Hamstring had a significant decrease of 13-16% of peak torque.

Neuromotor control

• What sex benefits greatly from neuromuscular training

  • Females landed with increased what and decreased what? (This was for unexpected SL drop tests)

    • Moderate negative correlation (2)

    • Moderate positive correlation (2)

• Females benefit greatly from neuromuscular training.

  • Females landed with increased forward pelvic tilt and decreased forward trunk flexion

  • Moderate negative correlation:

    • Hip extension strength

    • Forward pelvic tilt

      • More anterior pelvic tilt → decreased hip extensor strength

  • Moderate positive correlation:

    • Hip extension strength

    • Forward trunk flexion

      • More forward trunk flexion/lean → greater hip extensor strength

Training Considerations for Females

• Increase _____ body strength

• Use what sort of lifts (and this maintains appropriate what)?

• Just after PHV, there is a decline in what? This means increased benefits of what training?

• Higher what is generally tolerated?

• Training otherwise mirrors what?

  • “Young girls are not encouraged to _____ train at a young age” What are the two reasons this is not a good idea to have?

    • Gendered environment: Explain what this is and how it impacts females

• Increase upper-body strengthening

• Use large multi-joint lifts (maintains appropriate body composition)

• Just after PHV, there is a decline in neuromuscular control

• Increased benefits of neuromuscular training

• Higher training loads/frequency generally tolerated (Overall stimulus and damage from training is less)

• Training otherwise mirrors males

  • “Young girls are not encouraged to resistance train at young ages”

    • Do not build enough strength reserves prior to age related declines

    • May set them up for increased injury risk later in life

      • Gendered environment: risk factors previously considered to only be intrinsic to the athlete (eg, muscle strength, body composition, skill level) conceivably contain some degree of extrinsic influence. For example, female athletes have lower muscle strength, this might be due to those “gendered” decisions when it came to when to resistance train them that cause that decrease in strength.

Gender-Based Considerations

• Assess what two things?

• Increase female ______ representation

• Reduce gym what? (More females stare their goal was to do what vs males whose goal was to do what)

Growth and development

• What increase with growth, this therefore means an increase in what?

• Peak muscle mass occur at what age range for females and for males?

• Resistance training safe and beneficial: What are some benefits? (5)

• Gender-Based Considerations

  • Assess readiness and confidence.

  • Increase female coaching representation → few strength coaches are women

  • Reduce gym stereotypes → more females state their goal was to lose weight compared to males whose goal was to build muscle

• Growth and Development

  • Muscle mass increases with growth; therefore, increase in strength

  • Peak muscle mass: females 16–20, males 18–25.

  • Resistance training is safe and beneficial.

    • Benefits: strength, power, BMD, body composition, injury reduction.

Dispelling Myths: For the following explain why they are wrong

• “Kids can’t gain strength until after puberty”

• “Resistance training may injure the growth plate”

• “Resistance Training is Unsafe for Kids”

Youth resistance training benefits

• Increased muscular what?

• Improved body what?

• Increased what density?

• Decreased the risk of what? How much % reduction?

• Positive changes in physical what?

• Improved performance in what 3 things?

• Young children are more ______

  • Grey matter in the brain starts decreasing at age what?

  • Grey matter is responsible for?

Dispelling Myths:

• “Kids can’t gain strength until after puberty”

  • Increases in strength prior to puberty occur as a result of neural adaptations (Granacher et al 2011)

• “Resistance training may injure the growth plate”

  • Mechanical stress placed on developing growth plates from weightlifting is beneficial to bone formation and growth (Burt et al 2013)

  • 9–10-year-old females engaged in 10-month S&C program, 6.2% increase in BMD compared to only 1.4% in the control group (Morris et al 1997)

• “Resistance Training is Unsafe for Kids”

  • Youth resistance training can reduce the risk of sports-related injuries (Zwolski et al 2017)

Youth resistance training benefits:

• Increased muscular fitness (strength, endurance and power)

• Improved body composition

• Increased bone mineral density

• Decreased the risk of injuries (up to 66% reduction)

• Positive changes in physical self-concept

• Improved performance: running velocity, COD speed, power production

• Young children are more neuroplastic

  • Grey matter in the brain starts decreasing at age 20

  • Grey matter is responsible for motor learning

Considerations for Youth Resistance Training

• Focus on what gains before puberty?

• Add what focus after puberty along with what?

• Both children and adolescents can make meaningful improvements in what?

• Rumpf et al:

  • Pre-puberty benefits most from training that requires high levels of what? Examples?

  • Post-puberty responds more favorably to training that targets _____ + ______ development. Examples?

Current State

• Hulteen et al 2017:

  • Adolescents aged __-__ years had a very low prevalence of participation (___ to ___%) in what training activities?

  • Few athletes participate in what programs?

• Lubans et al 2015:

  • N = what? (___ + ___ years)

  • _________ training skill competency is low in adolescents (approximately __-__% demonstrated competency

  • Weaker youth are more likely to be what and have poorer what?

Considerations for Youth Resistance Training

• Focus on neural strength gains before puberty.

• Add hypertrophy focus after puberty → along with strength

• Both children and adolescents can make meaningful improvements in muscular power

• Rumpf et al

  • Pre-puberty benefits most from training that requires high levels of neural activation

    • (sprint training, plyos, multijoint compound movement)

  • Post-puberty responds more favorably to training that targets neural + structural development

    • (basic strength, hypertophy, and plyos)

Current State

• Hulteen et al 2017

  • Adolescents aged 13-17 years had a very low prevalence of participation (0.3 to 12.4%) in resistance training activities

  • Few athletes participate in year-round S&C programs

• Lubans et al 2015

  • N=548 (14.1 + .05 years)

  • Resistance training skill competency is low in adolescents

  • Approximately 3-28% demonstrated competency

  • Weaker youth are more likely to be injured & have poorer performance

When to start

• What minimum age? Start early when appropriate (especially with what gender)?

• Consider what age?

How do we start

• Use what two types of feedback to identify deficits?

• How many sets, how many reps, how much % of 1RM, how many exercises?

• Prioritize what mastery before what?

Safety

• Proper what (5)

Programming considerations for youth

• Children do better with high reps/mod load or low reps/high load?

  • Between these two programming differences, what is the difference in strength and endurance gains comparing these two?

• Body weight maybe be too what relative to what? This mean careful _____ tolerance

• Increase intensity how?

• Train how many nonconsecutive days/weeks

• When to Start

  • No minimum age; start early when appropriate (esp. girls!)

  • Consider training age

• How do we Start

  • Use verbal and visual feedback to identify deficits

  • 2–3 sets, 8–15 reps, 60–80% 1RM, 6–8 exercises.

  • Prioritize bodyweight mastery before external load.

• Safety

  • Proper instruction, spotting, loading, verbal and visual feedback, and recovery.

• Programming Considerations for Youth

  • Children to better w high reps/mod load than low reps/high load

    • No difference in strength and endurance gains comparing these two

  • Body weight may be too high relative to strength in some cases = carefully monitor tolerance

  • Increase intensity gradually (5–10%).

  • Train 2–3 nonconsecutive days/week.

Older adults

• After age 30: decrease in what two things?

• Increase in what fat?

• Decreased in what two things?

• Impaired control of what two things?

  • Increased risk of what 3 things?

Benefits of Resistance Training for Older Adults

• Improvements from progressive ______ training

• Increased muscular _____ and _____

• Increase muscle what?

• Increased what density?

• Increase in what?

Considerations for exercise programming in older adults

• What two training components are important

• Pay close attention to what three histories?

  • All should be what?

• Alter what two things to prevent overtraining?

• Consider extended what and added what work?

• Don’t do what to them?

Safety Recs for Resistance Training Older Adults

• What to do before session? Extended what? Avoid excessive what? Avoid what maneuver? Allow for how many hours of recovery? Preform within what ROM?

Motor learning

• _____change in _______ through practice

• Concepts include (5)? Example?

Older adults:

• After age of 30:

  • Decreased bone density

  • Decreased muscle CSA

• Increased intramuscular fat

• Decreased power, reaction time

• Impaired balance and postural control

• Increased risk of falls, fractures and long-term disability

Benefits of Resistance Training for Older Adults:

• Improvements from progressive resistance training

• Increased muscular strength and power

• Increased muscle mass

• Increased bone mineral density

• Increased function

Considerations for Exercise Programming in Older Adults

• Aerobic and resistance training components are important

• Pay close attention to medical history, prior training history & injury history

  • All should be prescreened

• Alter volume and intensity to prevent overtraining

• Consider extended warm up and added mobility work

• Don’t overwork them (longer to recover)

Safety Recs for Resistance Training Older Adults

• Prescreen, extend warm-up, avoid excessive fatigue, allow 48–72 hr recovery, + perform w/in pain free ROM

Motor Learning

• Permanent change in performance through practice.

• Concepts: task breakdown, exercise selection, instructions, feedback, differential and self-controlled learning

• Ex) Power Clean

Task Breakdown

• What are the 6 types of part practice training?

Take a whole skill and break it down into pieces

1. Segmentation

2. Fractionalization

3. Simplification

Taking parts of a skill and building them back into the whole skill

1. Pure part

2. Progressive part

3. Repetitive part

Segmental Fractions Simplify Pure Progressive Repetition

Task breakdown: For each type of part practice training

1. Segmentation: What is it? Example?

2. Fractionalization: What is it? Example?

3. Simplification: What is it? Example?

1. Pure part: What is it? Example?

2. Progressive part: What is it? Example?

3. Repetitive part: What is it? Example?

• 1- Segmentation: Taking a skill and breaking it down to its subcomponents

  • Ex) Power clean (3 phases, 1st pull, 2nd catch)

  • Breaking power clean into each individual phase

• 2- Fractionalization: Look at multiple subcomponents that are occurring simultaneously

  • Ex) 2nd pull of power clean involves triple extension of the LE while we are performing an upright row motion with the UE

  • Breaking this down into the triple extension piece and the upright row piece

  • Essentially taking a sub component and breaking that down into more components to practice

• 3- Simplification: Changing the equipment and/or speed

  • Ex) Power clean with empty barbell at slower speed

• 4- Pure Part: Practice each subcomponent of the skill individually, then practice the whole skill. Example:

  • Set 1: 5 reps first pull

  • Set 2: 5 reps of second pull

  • Set 3: 5 reps of Catch

  • Set 4: 5 reps of power clean

• 5- Progressive Part: Practice 1st 2 parts in isolation before you practice them together, then you practice 3rd part on its own, then practice whole skill. Example:

  • Set 1: 5 reps first pull

  • Set 2: 5 reps second pull

  • Set 3: 5 reps first and second pull

  • Set 4: 5 reps of catch

  • Set 5: 5 reps of power clean

• 6- Repetitive Part: Practice first part in isolation and add each subsequent component until you have reached the whole skill. Example:

  • Set 1: 5 reps of first pull

  • Set 2: 5 reps of first pull and second pull

  • Set 3: 5 reps of power clean

Exercise Selection

• What is random practice?

• What is variable practice?

• What is observational learning?

Exercise selection:

• Random practice - Perform multiple skills in random order

• Variable practice - Variations of the same skill w/in single session (Back squat, front squat, goblet squat, single leg squat)

• Observational learning - Learning through watching video or demonstration

Instructions & Feedback

• Instructions

  • Explicit instructions: Instructions have an external or internal focus? Speeds up learning by? Improved performance compared to? Example?

  • Implicit instructions: Use of an ______ to describe an action. Allows patients to connect to the? Examples?

  • Guided discovery: Provide instructions about what, but do not explicitly tell them what? Explore the ______.

• Feedback

  • What is intrinsic feedback? Example?

  • What is augmented/external feedback? Example?

  • Timing of feedback? (4)

Instructions

• Explicit Instruction:

  • Instructions have an external focus

  • Speeds up learning by automatically facilitating movement

  • Improved performance compared to internal focus

  • Example: Keep the stick level (external focus), keep your hips level (internal focus)

    • Focus on the stick/item not themselves

• Implicit Instruction:

  • Use of an analogy to describe an action

  • Allows patients to connect to the image of a movement and feel it

  • “Land like a spring”, “pretend the chair is made of glass”

• Guided discovery

  • Provide instructions about overall movement goal but do not explicitly tell them how to accomplish the task

  • Explore the movement

Feedback

• Intrinsic Feedback:

  • Feedback provided to the athlete by their senses

  • “Keep your knees from coming together”

• Augmented/External:

  • Feedback provided by an external observer, video, or equipment

  • “Keep your knees in line with the cones”

• Timing of Feedback

  • Immediate (maybe after every rep), Delayed (maybe at end of set), Consistent (every single rep we give feedback), Inconsistent (feedback every few reps)

Differential and Self-controlled learning

• Differential learning

  • Variety in _____ patterns allows for what?

  • More ____ athlete

  • Variability in what three things?

• Self controlled learning

  • _____ patient

  • Allows them to make choices regarding what two things?

  • Improves intrinsic what? (2)

• Differential learning

  • Variety in movement patterns allows for experimentation

  • More flexible athlete

  • Variability in: environment, task, athlete

• Self-controlled learning

  • Active patient

  • Allow them to make choices regarding exercise selection and feedback - Improves intrinsic motivation and enjoyment

    • Lets say i want to work squats today with the patient, i give them the option of picking what squat type to do such as back squat front squat goblet etc.

Neurocognition

• Decreased neurocognition directly increases?

• Deficits:

  • Altered ________ brain connectivity in high school athletes who went on to suffer and ACL injury

  • ACL injured athletes exhibit increased activation of what three things? This mean?

  • Decreased connectivity between what two regions may result in slower what? (2)

• Neurocognitive training

  • Training the brain to?

  • Exercises designed to accelerate what?

  • Neuromuscular training that incorporates what two processing?

    • ____ tracking

    • ____ making

    • ____ load

      • What is dual tasking?

      • Results in more what and slower what?

      • Delays in what processing may contribute to inability to correct movement errors?

      • Dual tasking during a single leg hop resulted in?

      • Adding a ball task to a side step cut resulted in? (What is seen at the trunk in sagittal and frontal plane?)

Neurocognition

• Decreased neurocognition directly increases injury risk

• Deficits:

  • Altered sensorimotor brain connectivity in high school athletes who went on to suffer and ACL injury

  • ACL injured athletes exhibit increased activation of motor planning, sensory processing and visual motor control areas compared to controls. This means they had a greater reliance on these things, meaning their movements were less automated and required more focus to control movement.

  • Decreased connectivity between cortical sensory and motor regions may result in slower processing speeds and reaction to environmental stimuli during sport

• Neurocognitive Training:

  • Training the brain to restore normal connectivity

  • Exercises designed to accelerate neurocognitive processing of visual & sensory input

  • Neuromuscular training that incorporates visual or neurocognitive processing

    • Ball tracking

    • Decision making

    • Cognitive load (dual tasking)

      • Dual tasking- performing two or more tasks simultaneously

      • Results in more mistakes + Slower performance

      • Delays in attentional processing may contribute to inability to correct movement errors

      • Dual tasking during a single leg hop resulted in greater deficits

      • Adding a ball task to a side step cut resulted in poorer cutting technique (more trunk extension and less lateral trunk flexion toward the direction of the cut)

History of adapted sports

• Who is the Father of the Paralympic Movement Neurologist?

  • When did the movement start and where? First sport clubs for the?

  • Began to rehab who?

  • What was the Stroke Mandeville and who organized it? It later became what?

History of Adapted Sports:

• Dr. Ludwig Guttmann = Father of the Paralympic Movement Neurologist

  • Paralympics movement started in Berlin (1888) = first sport clubs for the deaf

  • Began to rehab veterans from World War II, Korea, and the Vietnam War

    • (1939-1945) WWII → most significant and influential event of the twentieth century

    • (1942) → US established the Army Air Forces Convalescent Training Program –

      • Dr. Howard A Rusk “Father of comprehensive rehabilitation”

• Dr. Guttmann organized the first competition for wheelchair athletes which he named the Stoke Mandeville Games and later became the Paralympic Games

  • (1948) → Olympics London's opening ceremony

    • 16 injured servicemen and women who took part in archery

  • (1960) → 1st Paralympic games took place in Rome, Italy

    • 400 athletes from 23 countries

  • (1976) → First Winter Games in Paralympics held in Sweden

  • Now → Present Paralympic Games the Olympics will be hosted in Paris

    • 4,400 athletes will compete / 549 medal events

Multidisciplinary Team Approach

• What is it and what does it consist of?

• Medical clearance

• Problem solving

• Preventative care

• Whole health approach

• Creating this village will bring more awareness

• Phone a friend for help

• Decreases errors

Physical Therapy Role in Adapted Sports

• Evaluate and treat: _____ assessment/______ skills. What specific training and what needs?

• Seating and positioning: Facilitate proper what? _____ and _____.

• Preventative care: What are somethings that are focused on for preventative care? (4)

• Classify for? Advocate for?

• Evaluate and treat

  • Mat assessment/Wheelchair skills

  • Sport specific training

  • Equipment needs

• Seating and positioning

  • 1- Facilitate proper seating and positioning

  • 2- Modify and adapt

• Preventative care

  • Muscular skeletal injury’s

  • Skin integrity/ wound care

  • Diagnosis dependent (example: MS cooling vest)

  • Education on AD

• Classify for athletes' participation of sport

• Advocate for Adapted Sports awareness

Initial Evaluation

• What would be in an initial evaluation?

Obtaining a baseline - objective measures

• What sort of measures could be taken?

Initial Evaluation

• Diagnosis

• Mat assessment

• General AROM/PROM available

  • What are we working with? Do we have to facilitate or inhibit movement? MMT strength? What are you working with?

• History of pressure injuries

  • Location, stage, last occurrence, any surgeries (FLAPS)

• Any tone/spasticity present

• Bladder/ bowel management

• Assess seating and positioning

  • Backrest, Cushion, Power assist, Manual/power

• Assess transfers (what level of transfer?)

Obtaining a Baseline- Objective Measures

• Vital signs

• Weight (caliper score)

• Caloric intake form

• Nutritional assessment

• FIM score

• General Physical Exam

• Psychosocial forms (GAD-7,PHQ-9)

• GRECC scale

• Pain scale (PCS-EN, Visual Analogue Scale, Faces PAIN Rating Scale)

Seating and Positioning

• Evaluate current seating device:

  • When a patient arrives to clinic, what should you observe? (6)

• Good seated will:

  • Decrease risk of what injury?

  • Load areas that can tolerate loading? (2)

  • Offload areas include? Keep an eye on common areas that are prone to? (Ex for handcycles (3), Ex for sports wheelchairs (2))

Seating and Positioning

• Evaluate current seating device = Patient arrives to clinic, what to observe:

  • Wheelchair (solid frame/folding frame)

  • Dump angle if any

  • Backrest (sling or after-market)

  • Cushion type Camber (camber meaning WC with angle)

  • Power assist

  • Can be static or dynamically tested

• Good seating will:

  • Decrease risk of pressure injury

  • Load areas than can tolerate loading = Femur and Glutes

  • Off load areas that are at risk for pressure injury

    • Ischial Tuberosity

    • Any bony prominences

  • Keep an eye on common areas that are prone to tissue injury

    • Ex) Handcycles, keep and eye on: Leg rests, Crank (transfers), Sharp areas

    • Ex) Sports wheelchair, keep an eye on: Seating and positioning, Backrest

SCI injury:

• Autonomic dysreflexia: Occurs with an SCI above what level? What is boosting? S/S (4)? Can be?

SCI Injury

• Autonomic Dysreflexia: Occurs with an SCI injury above T5-T6

• Boosting (Is the method used in adapted sports to enhance performance)

• S/S: High BP, Change of HR, Skin color change (paleness, redness, blue grey skin color), Excessive sweating

• CAN BE LIFE THREATENING!

Transfers

• Baseline review - Evaluation

  • Observe what?

  • General eval consists of? (3)

  • Subjective should ask? (3)

  • Objective should look at? (2)

Transfers

• Baseline review - Evaluation

• Observe equipment

• General eval:

  • MMT strength

  • Available ROM

  • Tone

• Subjective:

  • What do they use at home?

  • Floor to wheelchair?

  • Any recent sx?

• Objective:

  • Functional mobility testing

  • Observe transfer

Skin integrity

• What patients are at increased risk? What can a poor transfer lead to? (6)

Preventative care tips

• Important safety checks:

  • Use proper body what?

  • Using the appropriate what?

  • Make sure to be aware of what you are?

  • Check what?

  • postural check via what inspection?

  • Protective ______ if necessary

Skin Integrity

• ↑ risks (patients with abnormal sensation)

• Poor transfer can lead to:

  • Pressure Injury

  • Deep tissue injury

  • “Dragulation” shearing tissue injury

  • Skin tears

  • Inpatient admission for wound care

  • Risk of becoming septic and death

Preventative Care Tips

• Important safety checks

  • Using proper body mechanic

  • Using the appropriate AT equipment

  • Make sure to be aware of what your seating on

  • Catheter check

  • Posture check -visual inspection

  • Protective dressing if necessary

Types of Transfers

• Transfers independently or with assistance

  • In and out of a wheel chair:

    • What two pivots can be used? Which one has a technique and item that can be implemented to make it easier (and what are both of those things)

    • What could be classified as “high tech” transfers? Examples? (4)

    • What is the last type of transfer?

• Perfect transfers

  • Level of current transfer from where to where?

  • Practice what?

  • Have what equipment available? (3)

Types of Transfers

• Transfers independently or with assistance

  • In and out of wheelchair

    • Sitting pivot

    • Head and hip technique

    • Sliding board

  • Standing pivot

• High tech. Mechanical lifts

  • Hoyer lift

  • Sure-hands lift

  • Car jack

  • Hydraulic lifts

  • Low tech

Perfect Transfers

• Level of current transfer from w/c to mat

• Practice floor to w/c

• Have equipment available

• Boxes (for step system)

• Gait belt

• Other therapist assistance

Adapted Sports Therapeutic Exercises

• Explain “Modify and adapt”

• What wheelchair skills? (4)

• CrossFit would include? (4)

Candidates for adaptive fitness

• Appropriate candidates would include? (5)

Risk factors/contraindications

• This would include what three things?

Adapted Sports Therapeutic Exercises

• Modify and adapt

  • Don’t get stuck, just improvise

  • Same exercises just with a little modifications

• Wheelchair Skills

  • Propulsion, Wheelies, Cone drills, Figure-8

• CrossFit

  • Split ropes, Burpees, Dips, Deadlifts

Candidates for adaptive fitness

• Appropriate: Motivated, Medically cleared, Compliant, Access to WIFI and smart device, Time management skills

Risk Factors/Contraindications:

• Poor compliance

• Active tissue injury

• Medically unstable

Equipment required to begin a successful adapted fitness program

• Equipment alternatives for the following:

  • Medicine ball

  • Split ropes

  • Kettle bell

  • Space

High-tech and low-tech equipment

• Low-tech alternatives for the following high tech:

  • Sur-grips

  • Protective lap pad

  • All sports wheelchair

Equipment required to begin a successful adapted fitness program

• Medicine ball → Gallon of milk, sports ball

• Split ropes → DIY: Regular Jump rope, scissors, duct tape

• Kettle bell → Dumb bell, ankle weights, water bottle

• Space → Inside or outside

High-tech and low-tech equipment

• Sur-grips → Coban, Velcro, straps

• Protective lap pad → Towel, roll, pillow

• All sports wheelchair → Manual wheelchair

3 Movement exercises

• Split ropes

  • Requirements: What equipment? What modify and adapt equipment? (4)

  • Actions: Hold hands where? Biomechanics include slight GH ______, elbow ______, wrist ______.

  • Goals: Good what workout? Transitions to?

• Wall ball

  • Requirements: What equipment? What modify and adapt equipment? (3)

  • Actions: How does it work? If unable to preform safely, modify to? (2)

  • Goals: Amount of what completed correctly in how many seconds to win?

• Burpees

  • Requirements: What equipment? What modify and adapt equipment? (3)

  • How does it work? If unable to preform safely, modify to? (4)

  • Goals: Amount of what completed correctly in how many seconds to win?

3 Movement Exercises

1- “Split Ropes”

• Requirements:

  • Equipment: split ropes

  • Modify and Adapt equipment:

    • Sure-grips, Velcro, coban

    • DIY jump ropes

• Action:

  • Hold hands slightly to the front

  • Biomechanics: Slight GH Abduction, eblow flexion, wrist Adduction

• Goal:

  • Good cardio workout

  • Transition to next movement

2- Wall Ball

• Requirements:

  • Equipment: Medicine ball/Slam ball, Lap Board

  • Modify and Adapt equipment:

    • Body point strap for posture stability

    • Lap board protection alternatives → towel, pillow

• Action:

  • Lift slam ball (or alternative) to full extension of arms

  • Throw ball to the floor in front

  • Catch on the rebound

  • If unable to perform safely, modify to:

    • Lift slam ball (or alternative) to forward arms straight out

    • Restart from lap

• Goal:

  • Amount of reps completed correctly in 60 sec to WIN

3- Burpees

• Requirements:

  • Equipment: Optional → Medicine ball/Slam ball, Dumbbell, Kettlebell

  • Modify and Adapt equipment

    • Body point strap for posture stability

    • Lap board protection alternatives → towel, pillow

• Action:

  • Lift ball (or alternative) to full extension of arms

  • Reach ball to the floor in front and lift over head

  • Repeat

  • If unable to perform safely, modify to:

    • Lift slam ball (or alternative) to overhead or shoulder height if there are shoulder issues

    • Restart from lap

    • Remove weight from exercise

    • Reach for toes if unable, go to knees and push off

• Goal:

  • Amount of reps completed correctly in 60 sec to WIN

What is Pink Puffer?

• Presence of what breathing?

What is Blue bloater?

• Presence of what structural abnormality?

Pink puffer: Emphysema (Presence of purse lipped breathing)

Blue bloater: Chronic bronchitis (Presence of barrel chest)

Blood pressure categories: For the following state the systolic (then either and, or, and/or) as well as the diastolic

• Normal

• Elevated

• High blood pressure Stage 1

• High blood pressure Stage 2

• Hypertensive crisis

• Normal

  • Systolic: Less than 120

  AND

  • Diastolic: Less than 80

• Elevated

  • Systolic: 120 - 129

  AND

  • Diastolic: Less than 80

• High blood pressure Stage 1

  • Systolic: 130 - 139

  OR

  • Diastolic: 80 - 89

• High blood pressure Stage 2

  • Systolic: 140 or higher

  OR

  • Diastolic: 90 or higher

• Hypertensive crisis

  • Systolic: Higher than 180

  AND/OR

  • Diastolic: Higher than 120

Blood pressure response to exercise

• What would be an abnormal response? (For BP, SBP (by how much), and DBP (by how much)

• Stop if SBP exceeds what and/or DBP exceeds what?

• SBP increases or decreases with hypervolemia?

• Normal exercise response: How does SBP change? By how much per increase in MET? Monitor what post PT until?

• Abnormal:

  • BP fails to increase or SBP drop of 15-20mmHG during activity.

  • If DBP increase suddenly by 20mmH

• Stop if SBP exceeds 225 -230mmHg and/or if diastolic BP exceeds 130mmH

• SBP increases with hypervolemia and decreases with hypovolemia

• Normal Exercise Response:

  • SBP ↑ linearly; 10 mmHg per MET until physiologic maximum

  • Monitor BP post-PT until returns to baseline BP

Risk Stratification for Cardiac AACVPR (American Association of CV and Pulmonary Rehab)

1. Pt is high risk if ANY ONE or MORE of the following factors are present:

   • L ventricular fraction of?

   • Survivor of?

   • Complex ventricular what? Examples?

   • What sort of surgeries, complicated by

   • Abnormal hemodynamics with?

   • Significant silent what? ST depression of how much? S/S? (5)

   • Clinically significant what?

2. Pt is at LOW risk if ALL of the following factors are present:

   • L ventricular fraction of?

   • No resting or exercise induced what?

   • Uncomplicated what? (5)

   • Normal hemodynamic and ECG responses to?

   • Asymptomatic with _____ or in ______, including absence of?

   • Maximal functional capacity of at least how many METS?

   • Absence of clinical what?

3. Pt is at MODERATE risk if they meet neither High risk nor Low risk standards:

   • L ventricular fraction of?

   • S/S?

   • Mild to moderate silent what with exercise or in recovery? ST depression of?

1- Pt is at High risk if ANY ONE OR MORE of the following factors are present:

• L Ventricular ejection fraction <40%

• Survivor of cardiac arrest or sudden death

• Complex ventricular dysrhythmias (V-Tach, frequent (>6/min) multiform PVCs) at rest or with exercise

• MI or cardiac surgery complicated by cardiogenic shock, CHF, or s/s of post-procedure ischemia

• Abnormal hemodynamics w/ exercise

  • Especially flat or decreasing SBP or chronotropic incompetence with increasing workload

• Significant silent ischemia (ST depression 2mm or greater w/o s/s)with exercise or in recovery

• S/S:

  • Angina pectoris

  • Dizziness

  • Lightheadedness

  • Dyspnea at low levels of exercise (<5.0 METs) or in recovery

  • Max functional capacity < 5.0 METs

• Clinically significant depression or depressive s/s

2- Pt is at Low risk if ALL of the following factors are present:

• L ventricular ejection fraction >50%

• No resting or exercise-induced complex dysrhythmia

• Uncomplicated MI, CABG, angioplasty, atherectomy, or stent:

  • Absence of CHF or s/s indicating post-event ischemia

• Normal hemodynamic and ECG responses w/ exercise and in recovery

• Asymptomatic with exercise or in recovery, including absence of angina

• Maximal functional capacity at least 7.0 METs

• Absence of clinical depression or depressive s/s

3- Pt is at Moderate risk if they meet neither High risk nor Low risk standards:

• L ventricular ejection fraction =40-50%

• S/S:

  • Angina at “moderate” levels or exercise (60-75% of maximal functional capacity) or in recovery

• Mild to moderate silent ischemia (ST depression <2mm) with exercise or in recovery

Hypertension:

• What is it? Found in what populations?

• Prolonged high BP = can damage and cause what?

  • Body sends what?

  • Over time, substances such as ______ and _____ may also build up a these spots, forming what?

• As plaque slowly builds, a process called ________, it can make the inside of the arteries what? This can cause what?

• Management:

  • What sort of things can be done to help with this condition?

  • People with HTN may take what? This may impact what?

HTN:

• Essentially high blood pressure

  • Found in all age groups

• Prolonged High BP = can damage the walls of blood vessels, causing them to develop tiny tears.

  • Body sends special cells that stick to the site.

  • Over time, substances such as cholesterol and fats may also build up at these damaged spots, forming plaque.

• As plaque slowly builds, a process called atherosclerosis, it can make the inside of the arteries narrower.

  • This narrowing can block the flow of blood, increasing the risk for serious conditions such as a heart attack or stroke

• Management:

  • Proper exercise techniques, weight loss, and diet changes. Need lifestyle modifications

  • People with hypertension may take medications that impact normal heart rhythms

Impact of Medications for HTN

• Beta blockers: Effect on HR? How does this occur? Clinical implications?

• Calcium channel blockers: Effects on HR? How does this occur? Clinical implications?

Impact of Medications for HTN:

• Beta-Blockers:

  • Effect on Heart Rate: Decrease heart rate (negative chronotropic effect) by slowing down the electrical impulses that cause the heart to beat.

  • Clinical Implications: Patients on beta-blockers may have reduced exercise tolerance due to lower heart rate response. Exercise intensity may need to be adjusted accordingly.

• Calcium Channel Blockers:

  • Effect on Heart Rate: Some calcium channel blockers (e.g., verapamil, diltiazem) can decrease heart rate by reducing the rate of sinoatrial (SA) node firing.

  • Clinical Implications: Like beta-blockers, these medications can affect exercise capacity and heart rate response during physical activity.

Considerations with HTN:

• Good training results at __ - __% max oxygen uptake when working out

• Exercises that are contraindicated include activities that increase ______ pressure

  • Decreased blood flow to? Thus decreases what?

• Safe things include?

Exercise with HTN:

• Goal to increase what two things?

• The advised intensity level to begin the program is __ - __% VO2 max

  • The RPE should be from what range on a 20 point scale? Eventual goal range?

• Rep range should consistently be at? This will have them working at __ - __% of 1RM on exercise

• Rest intervals will all be how many minutes or longer?

  • Will be working toward moving into __ - __ reps per set and a duration of __ - __ minutes per session

Considerations with HTN:

• Good training results at a 40 – 50% max oxygen uptake when working out.

• Exercises that are contradicted include activities that increase thoracic pressure.

  • Decreased blood flow to the heart thus decreases cardiac output.

• Safe things include free weights, weight machines, body weights, or elastic bands. Aerobic exercise and circuit weight training are also allowed

Exercise with HTN:

• Goal: Increase the VO2 max and ventilatory threshold.

• The advised intensity level to begin the program is 40 – 50% VO2 max.

  • The RPE should be from an 8 – 10 on the 20-point scale with an eventual goal of 11 – 13.

• Rep ranges should consistently be at 16 – 20. This will have them working at 50 – 60% of 1RM on the exercises.

• Rest intervals will all be 2 – 3 minutes or longer

  • Will be working toward moving into 8 – 12 reps per set and a duration of 30 – 60 minutes per session

Myocardial Infarction (MI)

• What happens to cardiac muscles?

• Will need what referral and follow up?

• Repair typically done by what 2 things?

Exercise with MI:

• Goals:

  • Increase in what capacity and decrease what?

  • Reduce risk of?

  • Increase ability to preform what activities?

  • Increase muscle _____ and _____

  • Clients who have had a MI should not do what maneuver? Why?

MI post op considerations

• Promote early what?

• Use what tool? It helps promote?

• What precautions?

Myocardial Infarction (MI)

• Cardiac muscles will potentially die during a myocardial infarction

• Will need cardiology referrals and follow up

• Repair typically done by percutaneous cardiac intervention (PCI) or coronary artery bypass graft (CABG)

Exercise with MI Goals:

• Increase aerobic capacity and decrease BP

• Reduce the risk of coronary artery disease.

• Increase ability to perform leisure, occupational, and daily living activities.

• Increase muscle strength and endurance.

• Clients who have had a myocardial infarction should not do the Valsalva maneuver.

  • Patients with heart failure show an abnormal blood pressure overshoot in response to the Valsalva maneuver due to impaired ventricular function

MI post-op considerations:

• Promote early mobility

• Incentive spirometry

  • Promotes deep breathing, prevents atelectasis, and improves pulmonary function

• Sternal precautions “Keep your move in the tube”

  

CVA (Cerebrovascular Accident)

• Need to consider what about the brain?

• May be easier to start with?

• Exercise may begin as low at __% of VO2 max, but they may eventually reach __-__%

• Sessions will be how long? What is emphasized in the program? When will the exercise be done?

  • What could also be another key component to consider/treat depending on what involvement?

Exercise with CVA:

• Goals:

  • Increase what activities?

  • Increase strength for both what?

  • Increase what on the involved side?

  • Prevent joint ______.

CVA (Cerebrovascular Accident)

• Need to consider which area of the brain was involved first!

• May be easier to start with cycle ergometers

• Exercise may begin as low as 30% of VO2 max, but they may eventually reach 40 – 70%

• Sessions will be 5 – 60 minutes. Range of motion is emphasized in the program, and the exercise for it will be done before and after the training sessions

  • Pending on brain involvement coordination and balance may be other key components of intervention

Exercise with CVA:

• Goals:

  • Increase daily living activities

  • Increase strength for both involved and uninvolved limbs

  • Increase the range of motion of the involved side

  • Preventing joint contractures

Peripheral Arterial Disease:

• These patient cannot typically walk for more than how many minutes without stopping to rest due to?

• At risk for?

• Goals:

  • Improve what response?

  • Reduce the risk of?

  • Improve what?

  • Increase what activities?

  • Increase work _____ and improve quality of?

Exercise prescription:

• Aerobic how many days a week? How many days of resistance training?

• Should work at what intensity? __-__% of VO2

• Resistance training should be __-__% of 1RM

Considerations:

• Encourage patients to address all what?

• What type of environment can aggravate s/s? May need longer what?

• These patients cannot typically walk for more than 2 - 5 mins without stopping and resting due to intermittent claudication!

• At risk for myocardial infarctions!

• Goals:

  • Improve pain response; be active for increasingly longer periods

  • Reduce the risk of coronary artery disease

  • Improve gait

  • Increase daily living activities

  • Increase work potential and improve the quality of life

• Exercise prescription:

  • Aerobic 3-5 days a week at least 2 days of resistance training

  • Should work at moderate intensity 40-60% VO2

  • Resistance training should be 60-80% of one rep max

• Considerations:

  • Encourage patients to address all CV disease risk factors

  • Cold environments can aggravate s/s, may need longer warm-ups

Heart Failure

• How many Americans have HF?

• Two most common causes of HF in the U.S are?

Considerations:

• Important to ____ _____ patients and know stages of HF

• Important to monitor?

• Start with what exercise, progressive what?

• PT must prescribe _______ exercise training for pts with stable HF using the following parameters:

  • How many minutes a session?

  • __-__% peak V02 or peak work

  • Frequency?

  • How many weeks?

  • Mode? (3)

• PT should prescribe what muscle training with what devices? For outpatients in home and clinic setting w stable HF using the following parameters:

  • How many minutes a day? __% maximal inspiratory pressure

  • How many days a week?

  • How many weeks?

Heart Failure

• About 6 million Americans have heart failure

• Two most common causes of heart failure in the U.S. are:

  • high blood pressure and coronary artery disease

Considerations:

• Important to risk stratify patient and know stage of heart failure

• Important to monitor tolerance to interventions

• Start with submaximal exercise; progressive resistance training

• PTs must prescribe aerobic exercise training for pts with stable HF using the following parameters:

  • 20-60 min

  • 50-90% peak VO2 or peak Work

  • 3-5x/week

  • 8-12 wks

  • Mode: treadmill or cycle erg or DANCING

• PTs should prescribe inspiratory muscle training with threshold devices for outpatients in home and clinic setting w stable HF using the following parameters:

  • 30 mins/day at >30% maximal inspiratory pressure

  • 5-7 days/week

  • 8-12 weeks

Heart failure charts

• For classifications and flow charts

COPD

• What is it? S/S? (4)

Considerations

• After careful screening, it is safe for COPD patients with comorbidities to obtain significant and clinically relevant what?

• What are some breathing considerations for treatment? (3 in total. Which one is for inspiratory muscle training and which one is for segmental breathing)

Exercise parameters

• Aerobic: at least how many days a week? __-__% of VO2? For moderate to severe COPD, __% is a better start

• Resistance training: Strength __-__% 1 RM max for beginners. __% for experienced. <__% for endurance

• Start training around how many minutes and build to a goal of how many minutes?

Additional considerations

• What other impairments might this patient have besides pulmonary involvement? (3)

  • For each one what could help?

• What if your patient is on supplemental oxygen?

  • Goal is to enhance what efficiency?

    • Use what exercises and why?

    • Important to monitor what?

COPD

• Chronic inflammatory lung disease that causes obstructs airflow from the lungs

• Symptoms include:

  • Breathing difficulty, cough, mucus (sputum) production and wheezing

• Considerations:

  • After careful screening, it is safe for COPD patients with comorbidities to obtain significant and clinically relevant improvements in functional exercise capacity and health status after an exercise-based pulmonary rehabilitation program.

  • Breathing considerations for treatment:

    • Pursed lip breathing

    • Deep breathing exercises

    • Diaphragmatic breathing

    • Inspiratory muscle training

    • Segmental breathing

• Exercise parameters:

  • Aerobic at least 3-5 days a week

    • 50-80% of VO2

    • For moderate to severe COPD, >60% better start

  • Resistance

    • Strength: 60-70% 1 RM max for beginners

    • 80% for experienced

    • <50% for endurance

  • Start training around 20 minutes and build to goal of 60 mins

• Additional Considerations:

• What other impairments might this patient have:

  • Cognition

    • Adherence to HEP

  • Visual changes

    • Home environment

  • Fall risk

    • Tai chi

      

• What if your patient is on supplemental oxygen?

  • Goal is to enhance oxygen efficiency

    • Use breathing exercises to improve overall respiratory function and reducing dyspnea

    • Important to monitor tolerance to interventions!

Cystic fibrosis

• Defect in the gene that impede the ability of _____ to move to the cell surface? This mean it cannot do what to the surface? This leads to mucus in the organs to?

• __% of CF death are cause by?

• Obstructive or restrictive of pulmonary system?

• ______ involvement

• Treatment goal: decrease _____ _____ due to abnormal ______ secretions and progressive inflammation secondary to chronic _____ ______.

  • What leads to chronic persistent infection? Which is the most common and which has worse prognosis?

  • What medication?

  • Airway clearance via what techniques?

  • What muscle training?

  • In childhood: What breathing technique? What two devices? What drainage? Active cycles of?

    • For the device, what are two contraindications?

    • Higher activity levels associated with slower decline rate of?

  • In adolescence: Focus on airway ____, Exercise participation monitor for? Higher incidence of? Balance issue due to?

  • What are some S/S of CF? (5)

CF:

• Defects in the gene impede the ability of chloride to move to the cell surface à chloride cannot attract water to the surface à mucus in organs thick and sticky

• 90% of CF deaths are caused by pulmonary compromise

• Obstructive (?)

• Multisystem involvement

Treatment:

• Tx Goal: Decrease airway obstruction due to abnormal mucus secretions and progressive inflammation secondary to chronic bacterial infections.

• Antibiotic resistance leads to chronic, persistent infection.

• Most common pathogens:
  P. aeruginosa
  B. cepacia (worst prognosis)

• Medications: Trikafta

• Airway clearance (chest physiotherapy techniques)

• Inspiratory muscle training and exercise

• In childhood: Huffing, PEP, oscillating PEP (Flutter or Acapella), autogenic drainage, active cycles of breathing

  • Contraindication for PEP: undrained pneumothorax & frank hemoptysis

  • Higher activity levels associated with slower decline rate of FEV1

• In Adolescence: Airway clearance, exercise participation monitor for pulmonary decline

  • High incidence of urinary incontinence

  • Balance issues due to ototoxcity

• S/S: Salty tasting skin, chronic respiratory problems, lung infections, poor growth/weight loss, meconium ileus (bowel obstruction in newborns caused by abnormally thick and sticky meconium (the baby’s first stool) blocking the small intestine)

Asthma

• Disease of _____ and ______ airways. Defined by three characteristics:

  • Airway ____ that is reversible in what two ways?

  • Airway ____

  • Airway hypersensitivity to ______ or ______ stimuli

    • Explain both stimuli and give some examples

• _____ component however does not account for all types and severity of asthma

• This reversible airway disease is associated with hyperactivity and is characterized by ease of developing what two things (or both)?

• Intensity needs to be monitored using what and what sense?

• Important to use breathing techniques such as? This is to optimize what and reducing what?

• What type of aerobics helps, and it improves what two things? We want this so they have a decrease in what and an increase in what?

• Should maintain and RPE of what value, and they are monitored the whole time for?

• What resistance program are recommended?

  • _____ loads and _____ reps, and take place how many days a week?

• Medical management: Short term

  • goal is to manage what? What drug is used to do that (relaxes what in the airways providing immediate relief for 5 minutes?

    • What are some adverse effects from this medication (4)?

    • If used more than 2 times a week, focus on what management?

    • Severe asthma attack that does not respond to this drug may develop what? Why is this significant?

• Medical management: Long term

  • Goal is to address what?

  • What is the drug of choice to manage long term?

    • What are some adverse effects of this medication?

Asthma

• Disease of large and small airways that is defined by 3 characteristics

  • Airway obstruction that is reversible spontaneously or with pharmacological intervention

  • Airway inflammation

  • Airway hypersensitivity to intrinsic or extrinsic stimuli

    • Intrinsic: Non allergic. Viral infections, exercise, inhaling irritants, emotional stress, weather and climate changes

    • Extrinsic: Allergic. Pollen, mold, dust, animal dander, smoke, drugs, foods

• Genetic component however does not account for all types and severity of asthma

• This reversible airway disease is associated with hyperactivity and characterized by ease of developing bronchospasm, constriction, or both.

• Intensity needs to be monitored with the RPE scales and the sense of having shortness of breath.

• Important to use breathing techniques such as diaphragmatic breathing to optimize breathing mechanics and reducing respiratory muscle fatigue.

• Large muscle aerobics helps to improve the VO2 max endurance. This will help decrease in shortness of breath and an increase in daily living activities.

• Should maintain an RPE of 11 – 13 and they will be monitored the whole time for dyspnea.

• General resistance programs are recommended.

  • Lighter loads and more reps and take place 2 – 3 days per week.

• Medical Management

  • Short Term Management: goal is to manage bronchoconstriction

  • Bronchodilators are the drug of choice - relax the smooth ms of the airway providing immediate relief within 5 minutes

  • AEs: tachycardia, HA, nausea, anxiety

  • If used > 2x/wk, focus on long term management

  • Severe asthma attack that does not respond to bronchodilator may develop status asthmaticus, a life-threatening emergency

• Long Term Management: goal is to address the triggers that cause the bronchial hyperresponsiveness and underlying inflammatory response

  • Inhaled corticosteroids are the drug of choice

  • AEs: nervousness, HA, dizziness, trembling, mouth dryness, heartburn, nausea, restlessness, insomnia, difficulty concentrating