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Pt_Care
Module_5_AROM/PROM
| Question | Answer |
|---|---|
| define isokinetic exercise: | form of active resistive exercise; the speed of movmt of the limb is controlled thruout the arc or ROM, and the resistance offered is in direct proportion to the force offered by the pt thruout the ROM of the ex. |
| define isotonic contraction: | a muscle contraction whereby tension is developed and movmt of a joint/body part occurs; can be eccentric or concentric/muscle can lengthen or shorten. (so basically just reg movement, the opposite of this would be "isometric contraction") |
| define joint play | the laxity or elasticity of a joint capsule that allows movmt of the joint surfaces within the capsule. |
| what's Phlebitis? | inflamation of a vein. |
| define PNF | Proprioceptive neuromuscular facilitation- a Rx technique that uses various stimulie to affect the muscle/joint proprioceptors to faciliate or alter movmt responses. |
| what's a thrombus? | an aggregation of blood factors, primarily due to platelets + fibrin, w/entrapment of cellular elements that frequently leads to a clot + obstruction of a blood vessel. |
| whats thrombophlebitis? | inflamation of a vein associated with the formation of a thrombus. |
| Name some of the general goals of exercise? (benefits/y PTs do it) | o Improve functional capacity o Enhance metabolic and physio function of muscle o Maintain/improve ROM o Enhance cardio-pulm system o Improve strength and endurance o Improve coordination + flex o Overall well being and INDEPENDENT FUNCTION OF THE |
| what are the two types of exercise and when do you use which one? | Active + Passive. Use Passive for Pts who are unable or not permitted to contract bc of pain/adverse effects associated w/muscle contractions. Use Active when Pt can assit with or indep perform the ex w/ the use of an active, coluntary contraction of mm |
| Define PROM and who/what can do it? | the movmt of a joint/body segment by a force EXTERNAL to the body w/in unrestricted + normal ROM (dont go beyond!) W/O ACTIVE contraction by pt. this can be done 3 ways- 1- caregiver or manually by pt, 2- mechanical 3- by gravity. (taken from book pg 101) |
| what should you consider during passive ex? | effects of gravity, stability and support, what's the purose of the ex, and the ability of the pt to perform or participate in activity, the safety measures or profection, pt's symptoms- is this ex worsening it? |
| whats the dif btwn support and stabilization? | support is used to promote motion/movmt whereas stabilization is used to avoid,limit, or probit movmt. (Ex- when doing Humeral-Ulnar PROM- stab distal humerus, support wrist hand thru movmt.) |
| define AROM | movmt of a joint or body segment produced by ACTIVE, VLUNTARY mm contractions by pt w/in the unrestricted, normal ROM. NO increase in jt ROM should be expected, but strength + endurance can be increased. |
| define AAROM | form of active ex whereby an EXTERNAL force is used to HELP the pt perform the ex. the assistance may be applied manually, mechanically or by gravity. the pt must perform active, voluntary mm contractions to the extent that they are able to. |
| when do u use AAROM? | when muscular weakness, fatuge, or pain limit the pts performance AND when active, voluntary mm contractions are desired. |
| Ex.) Pt is in a coma. You have orders to do PROM exercise. If they measure 160 during earilier assessment. Your goal is to maintain ___ degrees ROM? | maintain 160 during this exercise. You must go thru FULL ROM (0-160). If you go beyond its consider stretching |
| Goal of AROM? | GOAL- increased strength + endurance, not increased ROM |
| list some benefits of PROM ex? | preserves/maintains ROM, Min.contractures, Min. adhensions, Maintain mechanical elasticity of mm, promotes/maintains local circulation, promotes awareness of jt motion (sensory awareness), eval jt integrity, cartilage nutrition/synov fluid, reduce pain |
| when would you stop performing PROM on a pt (besides at completion or reps) | When symptoms increase or condition intensified. When pt capable and would benefit from active exercise |
| list some limitations of PROM? | Cant PREVENT atrophy Cant maintain/increase mm tone/strength/ endurance Cant decrease adipose Reduced efficacy compared 2 AROM in facilitating circulation Difficult 2 perform when muscles fully innervated/pt is conscious/when painful. |
| benefits of AROM? | o Maintain mm tissue o Increase local circulation o Increase sensory +jt motion awareness o Maintain and improve cardiopulm fx o Prevent THROMBUS (ankle pumps)o Improve strength (pt w/fair grade or below mmt)o Tendon-bone interface structural integrit |
| when do we use AROM? | o Pt is able to voluntarily contract, control, and coordinate motion w/AAROM or w/out assitannce (make sure they have good control and not using compensatory movmts) o When there are no contraindications |
| name some possible contraindications to AROM? | Cardiopulm dysfunction Unhealed/unprotected fx, surgical site, Soft tissue trauma Increased symptoms. |
| what are some precautions for AROM? | Jt pain + swelling (actue OA, RA, Hemophilia) • Key- sometimes active movmt can get rid of swelling. So sometimes good. Valsava maneuver (always educ. pt on this, prevent by Having them actively count reps.) Progression from PROM to AROM Grav |
| when is lengthening of the finger flexors (extrinsic) contraindicated? | when @ SCI C6 or above |
| when is lengthening of the trunk/erector spinae mm contraindicated? | pt with SCI (above T5-6); Don’t want to overlengthen erector spinae. Taughtess here aids stability in w/c |
| contraidications for ROM exercises with total hip replacement? | avoid ADD (past neutral), IR, Flex beyond 90 |
| what should you be aware of for pts with hemipelgia with flacid musculature/hypermobility? | ROM will need to be performed w/jts supporeted and stabilized. movmt slow and rthymic. PNF patterns may benefit. |
| what should you be aware of for pts with hemipelgia with hypertonicity in the musculature? | slower gradual movmt during ROM will be necessary to avoid unwanted spasticity. goals of ROM for hemiplegic pts are to prevent contractures, maintain ROM, and provide protection from shoulder subluxation by proper positioning of the affected side. |
| what should your ROM be if the pt is hypermobile? | just go to anatomical zero. Don’t make something more abnormal |
| List the application of Passive Exercise (procedures) | 1. posit and DRAPE pt. 2. explain purpose and goals. obtain consent. 3. posit pt to promote use of proper body mechanics by pt and caregiver. 4. grasp part to provide support + stability. 5. perform ex thru complete, normal, unrestricted ROM. CONT... |
| list the remaining application of Passive Exercise (procedures) | 6. perform the PREDETERMINED reps. 7. perform Rx smoothly/slowly- PAUSE at start and end posits of the exercise. 8. at the conclusion-reposit and DRAPE. 9. eval pts response and doc |
| what should you do before applying PROM exs to the cervical spine? | use the VERTEBRAL ARTERY OCCULSION TEST! if pt compalins of dizziness, lightheadness, or visual probs this indicatesa comproise of the arterial blood flow and further Rx should be witheld/or performed cautiously. notify Dr. |
| how are the diagonal patterns named? | according to the posit of the promximal joint (i.e. shoulder or hip) of the pattern at the END of the pattern. (ex- "D2 Flex", you are starting with their arm across body, hand near hip (+IR) but you END at shoulder flexion (+ ABD + ER). |
| what's D1 and D2 for shoulder functionally look like? | D1- seatbelt. D2- drawing a sword |
| when are Diagonal patterns used? | for PNF pts or to save time when cardinal planes may take too long. |
| what are the 3 types of muscle contraction? | isotonic (same TENSION; concentric or eccentric), isometric (same LENGTH; dont move), isokinetic (same SPEED; resistive) |
| what are the benefits of isotonic? | can maintain or increase strength, power, endurance, promote circulation, cardiovascular efficency, hypertrophy of muscle fibers, maintain physiological elasticity, maintain jt motion, maintain/enhance coordination. |
| which of isotonic (concentric or eccentric) produce more mention in the muscle, thus may develop strength more rapidly? | eccentric |
| what are the benefits of isometric? | improve stability of trunk or extremity jts + slight neuromuscular control. however, this ex does little 2 contribute 2 cardiovasc. fitness or jt/mm flex or to maintain cooridnated movmt. this is often used early on in rehab. (ex- glut sets in bed!) |
| how do you do isometric exs in rehabilitation? | incorporate multiple angle isometrics in which resistance is applied every 10-20 degrees thru-out ROM of the jt for 6-10 secs. the pt should be permitted to rest for atleast 6 secs btwn contractions. ** these #s are from our notes. the book says 5-8 secs! |
| explain the theory behind isokinetic exercise equip (ie Biodex) | the equip controls the speed of the pts contractions and produces a variable resistance 2 the mm as it contracts thru its arc or ROM. (pg 125-published studies indicate that it strengthens mms more efficiently than other forms of resistive isotonic ex.) |
| what are the 3 types of Active ex? | Active Assisted, Active (free), Active resisted. |
| when would you most likely assist a pt with "Active Assisted Ex" during "shoulder ELV thru FLEX?" | help at zero, the inital start is hardest. |
| what type of cues/instructions can you give during Active Assisted? | touching, tapping or stroking the mm to be contracted; having the pt initially perform the contraction with the oposite uninvolved mm, demostrating urslef, and using the terms "bend" "lift" "straighten". |
| what should you consider during "active free" ex? | how the posit will affect gravity's role. make sure the speed is smooth and controlled. encourage pt to briefly pause (hold) at the end and start posits during each rep. brief rest btwn each set. no valsava! |
| how can u apply active resistive ex? | manually or mechanically. |
| what should you consider during active resistive ex? | still gravity, that movmt slow + controlled, stabilize prox segment, posit of ur hand/long vs short lever arm +the relationship of amt of force u need 2 apply. (ie. shoulder flex- lever arm @ hand, less force needed vs lever above elbow- use more force) |
| when do most muscles have the weakest contractile capacity? how does this relate to Active resistive exercises | beginning + end of ROM (length-tension curve). even tho the (load) may be the same thru-out the movemt, the effect of the resistance on the mm will vary @ diff. points w/in the range as the mm lengthens + shortens. u may need 2 adjust posit/resistance |
| describe the general pathway for exercise when considering ALL the types of ex? | PROM - AAROM - AROM free - AROM resisted |
| how is info documented in a SOAP note? how do you organize it? | the Problem or Diagnosis is in the first section, and then SOAP. you organize according to the SOURCE of information instead of the TYPE of info (in PCMM) |
| what do you include in the Problem? | Pts C/C, diagnosis or a loss of fuction. it may be medical, pyschological or functional. you write information that is recorded from a medical chart bc it is NOT the result of tests u've conducted and its not coming from the pt. |
| what are the dif sub sections of the "Problem?" | demographics, recent/past surgeries, PMH, present condtions/diseases, med test results, pt meds (only taken from chart, not pt.)**only need 2 doc info affecting present condition/rx 4 these subcategories. dont need 2 list irrelevant surgeries, Hx, etc. |
| what do you write in the S? | info recieved from pt/caretaker. |
| what are the subcategories | Prior lvl funct, pt goals, social Hx, employ. status, lvng enviro(assist devices), gen. health, social/health habits (incl exercise), fam. Hx, funct. status/activty lvl(bed mob/txrs/amb), med Hx, Meds, growth+dev, response 2 Tx, ANYTHING the pt says |
| what is key when documenting "S" | always use the word "Pt" initially but dont need to repeat every statement. always use a verb indicating statement is subjective (states, describes, illustrates, denies, reports, indicates,etc). |
| when should u use direct quotes in "S"? | quote pt to illustrate confusion or memory loss. or denial or to describe pain. |
| what 3 subcategories of "S" should you always document when writing either initial, progress, or discharge notes? | C/C, Functional status/Activity Lvl, and Pt Goals |
| is the "S" section optional for progress notes? | Yes! you may use it if you want to update previous info- such as goals, response to treatment, pts compliance and or other health conditions during that week, functional status/activity level. |
Created by:
tpostrel
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