Corrective final exam`

Evidence based practice

what has been demonstrated in research for best outcomes

3 pillars of EBP

quality research, clinicians experience, patients specific hopes/dreams/goals

outcomes based practice

based on paient outcomes, clinican based, provide info on pt’s perception of treatment

components of therapeutic exercise program pyramid- bottom to top

examination & assessment, correct deviations & decrease pain, flexibility & ROM, Strx & endurance, NM Control & proprioception, function, performance

Force

a form of energy that causes movement, has direction and magnitude

NL #1 law of inertia

object in motion stays in motion, this law explains how difficult it is for a weak muscle to intiate movement through space.

NL #2 acceleration and momentum

directly proportional to the force applied, but indirectly proportional to the mass, explains why a slow and controlled movment requires more force

NL #3 action- reaction

an object reacts to a foce that is equal in magnitude but in an opposite direction, equal magnitude but opposite direction= isometric

COG

a point where mass/weight is evenly distributed

LOG

runs vertically through COG, usead as a point of reference when discussing posture, used to determine stability

BOS

2D area between and including an objects point of contact with the supporting surface

1st class lever

effort - fulcrum - load, ex: scissors, MA: balance, easily manipulated

2nd class lever

effort - load - fulcrum, MA: power, MD: ROM

3rd class lever

Fulcrum - effort- load, Ma: ROM/Velocity/distnace, MD: less efficient

LOP

long axis of muscle

AOP

angle between muscles LOP and long axis of the bone, AOP and moment arm changes with joint motion

Torque

rotational force

active insuffiency

a 2 joint muscles inability to fully contract over all the muscle it crosses due to lack of excursion

Passive insuffiency

the inability of a 2 joint muscle to fully stretch over all the muscles it crosses

length-tension relationship

a lengthened muscle generates more force, muscle shortens maximally @ 50-70% of resting length, MD: insufficiency

Assessment

differential dx and problem list

plan

progression and potential goals (short term vs. long term)

SOAP Note

S: subjective

O: objective

A: assessment

P: plan

prolonged immoblization and its effect on: muscle, bone, articular cartilage, and connective tissues

NM influences of the muscle spindle and GTO on stretching muscle

instability vs hypermobility

dynamic stretching

AROM, smooth, controlled, beneficial for athletes that need power and speed.

why is dynamic stretching not done at early rehab?

because strength and propriocenption are needed.

ballistic stretching

rapid/not the best, does have a place in rehab, the reciprocal movement is taking a joint beyond its ROM.

static stretching

taking muscle or muscle group to end ROM and holding. generally proximal is stabilized and force is applied. GTOs are activated after 6s.

balance

bodies ability to control equilibrium by having COG fully w/in BOS.

vestibular system

inner ear, responsible for sending messages to CNS,

oculomotor system

apart of the CNS, fuction is to maintain visual stability and control eye mvmts

proprioceptive system

the bodies ability to transmit position, sense, interpret that information and initiate a response

balance screens and exercises

static or dynamic

coordination

,uscles work together w/ appropriate timing and intensity to perform a smooth pattern of activity

agility

ability to control direction of body or segment during rapid movement

progrssion of balance exercises

AAROM if permitted, take patient to highest, safest, level

balance can be tested by

static stationary mvmt and dynamic mvmt

3 components of the vestibular system

semicircular canals, utricle (forward and backward mvmts), and saccule (vertical displacement)

overflow principle

with increasing voluntary effort or prolonged effort, motor activity spreads to additional motor unit of the same muscle and to units of other muscles.

strength

max amount of force a muscle can generate

force

mass x acceleration

kinetics

torque

power

work

isometric

muscle generates force without changing length or moving the associated joint

concentric (dynamic)

muscle shortens and generates force (against gravity)

eccentric (dynamic)

muscle lengthens under a load (with gravity)

OKC exercises

distal end is freely moving in space, produces high velocity motions

CKC exercises

distal segment is weight bearing and the body moves over the hand or foot, produces forceful movement, creates less shear stress joints (thus safer to use in early rehab)

gait focus:

going from point A to Point b as efficiently as possible

gait cycle

time from point when one foot touches the ground ot the time it touches the ground again

two phases in gait cycle

stance phase - 60% of cycle - weight bearing

swing phase - 40% of cycle- non-weight bearing

Double limb support (10%) - walking gait

both feet are in contact with the ground

stance phase

some or part of the foot is in contact w ground and weight bearing.

stnace phase sequence

heel strike, foot flat, midstance, heel off, toe off (late stance)

swing phase sequence

early swing (acceleration), mid swing (swing through), late swing (deceleration)

kinematics of gait: trunk and upper extremeties

erect throughout gait, maintains COM over BOS, trunk rotates opposite of pelvis, UE arm swing = momentum for rotationk

kinematics of pelvic motion

facilitates mvmt of trunk and hip, minimal but slight tradeoff,

hip flexion and hyperextension measurements at heel strike

flexion = 25 degrees, hyperextension = 10 degrees

COM pathway

want COG as a stable as possible, highest point: during midstance, lowest: DLS, average displacement = 5cm,

knee flexion at midstance

15 degrees, lowers COGa

ankle motion at midstance

cog raises at heel strike and toe off, lowest at midstance

pelvis motion at midstance

lateral pelvis motion, horizontal displacement

PPT

hip extensors and trunk flexors, facilitates hip flexion

APT

hip flexors and trunk extensors, facilitates hip extension

muscle functions during gait

concentric (acceleration), eccentric (deceleration), Isometric (stabilization)

primary shock absorbers

quads

average walking pace

3 mph = 20 min mile

how many steps on average a minute

60-90-122 steps/min

cadence

rate and rhythm of gait

spatial characteristics

factors that can be observed by looking at paths of gait

stride length

distance from heel strike to heel strike of the same foot (about 61 inches)

step length

heel strike to heel strike of opposite foor (30 inches)s

step width

width between heels ( 3 inches)

primary stabilizers : hip

extensors (g.max), abductors (g.med, g.min)

foot stabilizers during weight bearing

foot inverters and evertors

foot accelerators during late stance

gastroc and soleus (plantarflexors)

running stride

begins at nonweight bearing phase (toeoff to toeoff)

running cycle

2 strides

cycle time

amount of time it takes to perform one running stride

foot strike

initial contact- used instead of heel strike ***heel shouldnt hit ground***

both stride length and rate increase as what increases

as velocity increases

stride length and rate both decrease when

cycle time decreases when speed increases

joint motions during running: trunk

forward lean,occurs with fast running and sprinting, up to 4 degrees to almost 12 degrees as speed increases

joint motions during running: pelvis

max APT: 20 degrees after toe off

joint motions during running: hip

max = 11 degrees extension to 65 degrees flexion

joint motions during running: knee

no ext:20-25 degrees at foot contract, up to 120 degrees for max flexion swing

joint motions during running: ankle/foot

up to 30 degrees plantarflexion at toe-off in sprints, 30 degrees during swing in runners

pathological gait: trendelenburg

glute med is weak, excessive motion in frontal plane, LPT

antalgic gait: painful gait

changing mechanics because something hurts

exercises to decrease trendelenburg gait

side lying hip abduction, side plant with hip ABD, clamshells

trunk and core kinetics while running

the trunk and core are the foundation for the pelvis and lower extremity running mvmts

upper trunk muscles

aid respiration

____controls trunk flextion: its assisted by __________ and ________ during lateral tilt

ES, QL, abdominals

Arm swing helps LE to generate…

forward momentum

gait patterns with crutches

2 pt gait, 3 pt gait, 4 pt gait, swing to gait, swing through gait

factors of assistive devices

pts age and size, physical ability and coordination, balance, specific injury, WB status, comfort level