Untitled Quiz

Podcast Beta

Play an AI-generated podcast conversation about this lesson

Questions and Answers

What is the primary purpose of anticipatory postural control?

To improve cardiovascular endurance

To increase balance stability during static positions

To activate postural muscles before skilled movements (correct)

To strengthen lower extremity muscles

Which of the following actions would most likely challenge anticipatory postural control?

Standing still with feet together

Sitting and relaxing

Pulling on a handle while standing (correct)

Walking on a flat surface

During the timed sit-to-stand test, individuals who overestimate the load they are lifting may experience which of the following issues?

Enhanced joint flexibility

Increased stability and control

Excessive momentum leading to loss of balance (correct)

Improved muscle coordination

What is a key training technique for older patients to improve balance and mobility?

Tandem walking with arms out Signup and view all the answers

What is a common test used to assess lower extremity stability in individuals with chronic ankle instability?

Star Excursion Test Signup and view all the answers

How is target heart rate calculated?

HRmax x % intensity desired Signup and view all the answers

Which of the following should not be used to monitor intensity if a patient is on B-blockers?

Target heart rate Signup and view all the answers

What does SAID stand for in exercise physiology?

Specific adaptation to imposed demands Signup and view all the answers

Which test is used to evaluate static balance by standing with feet together and eyes closed?

Rhomberg test Signup and view all the answers

What is a key component of the PAR-Q screening test?

Understanding instructions Signup and view all the answers

Which of the following is NOT a focus in the dynamic balance training?

Stabilizing the body while standing still Signup and view all the answers

What is indicated by a higher frequency of exercise according to the FITT principle?

More exercise sessions per week Signup and view all the answers

What should the pre-screening process assess regarding the patient's health?

Blood pressure and health conditions Signup and view all the answers

What is the primary focus of the functional reach test?

Maintaining balance while reaching in different directions Signup and view all the answers

In the reactive balance training, what activity is suggested to improve reaction times?

Playing dodgeball in an unpredictable environment Signup and view all the answers

What does the foam and dome test assess in relation to sensory organization?

Balance with reduced visual and somatosensory cues Signup and view all the answers

Which of the following is included in the training to improve functional reach?

Catching or kicking a ball in various directions Signup and view all the answers

What aspect is primarily evaluated through the Timed Up and Go test?

Walking speed over a measured distance Signup and view all the answers

Which of the following methods is NOT part of the training to reduce visual support?

Standing on a firm surface with eyes open Signup and view all the answers

What is the purpose of the pull test in assessing balance?

To evaluate the ability to maintain position under sudden disruption Signup and view all the answers

Which of the following is true about training for sensory organization?

It includes reducing somatosensory cues and visual support Signup and view all the answers

What type of balance factors does reactive balance involve?

Involuntary adjustments to balance disturbances Signup and view all the answers

During the foam and dome test, what is the first step performed?

Standing with eyes open on a firm surface Signup and view all the answers

Which activity involves dynamic muscle contraction being resisted by external forces?

Resistance training Signup and view all the answers

What is the primary focus of muscle endurance?

Performing low-intensity activities without fatigue Signup and view all the answers

Which of the following individuals would most likely struggle with using hip strategies for balance?

A person suffering from vertigo Signup and view all the answers

During aerobic exercise, which of the following should be monitored?

Onset of chest pain Signup and view all the answers

What type of stretching involves holding a position just past tissue resistance for a period of time?

Static stretching Signup and view all the answers

Which stretching technique can NOT be used on patients with paralysis?

PNF stretching Signup and view all the answers

What is the primary objective of the Four Square Step Test?

To evaluate balance and agility Signup and view all the answers

What characteristic does a closed kinetic chain exercise mainly have?

Involves joint compression Signup and view all the answers

Which approach focuses on integrating active muscle contraction with stretching?

Hold-relax stretching Signup and view all the answers

Which condition is a contraindication for flexibility stretching?

Recent injury or fracture Signup and view all the answers

Which balance activity requires a person to perform two tasks simultaneously?

Standing on one leg and counting backwards Signup and view all the answers

What is a key component in power training?

Increasing movement speed Signup and view all the answers

What is a primary focus of the warm-up for aerobic exercise?

Prepare the cardiovascular system Signup and view all the answers

Which of the following is true regarding ballistic stretching?

It uses rapid, forceful movements to stretch muscles. Signup and view all the answers

Which of the following exercises is primarily used for strengthening the quadriceps in patients with hip osteoarthritis?

Isometric quadriceps contraction Signup and view all the answers

During the acute phase of an injury, what is a key consideration when managing pain?

Using the pain + activity traffic light system Signup and view all the answers

For effective strengthening during bridge exercise, what should be ensured?

Muscle fatigue should be achieved Signup and view all the answers

In the management of pain during rehabilitation, what does a 'YELLOW' signal indicate on the traffic light system?

Mild pain between 4-5 Signup and view all the answers

Which exercise is suitable for patients who have difficulty maintaining an upright posture during squats?

Small plates under the heel Signup and view all the answers

What is the main purpose of static stretches in rehabilitation?

To lengthen muscles and improve flexibility Signup and view all the answers

When implementing wall sits as an isometric exercise, what is crucial for proper execution?

Squeezing the quads without movement Signup and view all the answers

Which of the following is NOT a benefit of progressions during exercises?

Limits overall activity levels Signup and view all the answers

What is the role of facilitated trunk awareness exercises in rehabilitation?

To promote pain-free movement patterns Signup and view all the answers

What exercise can help with knee flexion strengthening in the context of rehabilitation?

Hamstring curls Signup and view all the answers

Which type of exercise is most beneficial for shoulder flexors?

Front raises Signup and view all the answers

During rehabilitation, if a patient feels pain upon lumbar flexion, what should be the appropriate action?

Stop when unable to control the position Signup and view all the answers

Which of the following represents a proper approach to knee extension exercises?

Using straight leg raises without pain Signup and view all the answers

What adjustment is recommended for patients who experience difficulty with shoulder external rotation?

Use a slider for assistance Signup and view all the answers

Study Notes

FITT Principle

Frequency: How often you exercise
Intensity: How hard you exercise, monitored by target heart rate (avoid using for patients on medications like beta-blockers).
- Calculate target heart rate:
  - HRmax: 220 - age
  - HRR: HRmax - HR rest
  - Target HR: HRmax x desired intensity (%)
Type: The kind of exercise you do
Time: How long you exercise

SAID Principle

Specific Adaptation to Imposed Demands: The body adapts to the specific kinds of exercise it is subjected to.

PAR-Q (Physical Activity Readiness Questionnaire)

Pre-screening test for exercise participation.
Questions include:
- Do you have any health conditions that might prevent you from exercising?
- Do you understand the experiment instructions?
- Are you comfortable continuing with the experiment?
Informed consent should be obtained.

Balance

Pre-screening: Assess patient's risk profile, blood pressure, and any existing blood pressure problems (hypotension).
Types:
- Static: Maintaining a stable position while at rest (standing, sitting).
  - Tests:
    - Rhomberg Test: Stand with feet parallel and together, eyes open then closed for 30 seconds.
    - Single-Leg Balance Stance Test: Predict falls in elderly and ankle sprains in athletes. Stand on one leg with arms across the chest for 5 trials of 30 seconds each.
  - Training:
    - Start on firm surfaces, progress to softer surfaces.
    - Progress from feet together to single-leg stance, lunge, and squat positions.
    - Gradually incorporate closing eyes and moving arms.
- Dynamic: Controlling the body when the support surface is moving or the body is moving on a stable surface.
  - Tests:
    - 5 STS (Sit to Stand Transfers): Stand up and sit down quickly for 5 consecutive repetitions in under 15 seconds.
  - Training:
    - For older patients: Tandem walking with arms extended, progress by turning the head in different directions while walking.
    - Maintain weight distribution and upright posture on unstable surfaces like a therapeutic ball or wobble board, progress by varying arm positions.
    - Regress by shifting weight forward, backward, and laterally.
- Anticipatory (Voluntary): Activating postural muscles before performing skilled movements (maintaining center of gravity).
  - Tests:
    - Star Excursion Test: Test lower extremity and detect deficits in chronic ankle instability. Reach as far as possible with one leg in 8 directions while maintaining balance.
    - Functional Reach Test: Reach as far as possible in different directions without changing base of support.
  - Training:
    - Reach in all directions to touch or grasp objects.
    - Catch or kick a ball in all directions.
    - Lift objects of varying weights.
- Reactive (Involuntary): Adjusting to disturbances of balance without voluntary control.
  - Tests:
    - Pushes: Apply small, large, slow, fast, anticipated and unanticipated pushes to the sternum, posterior trunk, or pelvis in different directions.
    - Pull Test: Place a hand on the patient's shoulder and pull backward suddenly, ensuring safety by standing behind the patient.
  - Training:
    - Play dodgeball in an unpredictable environment to improve reaction time.
- Sensory Organization: Target the weakest sense.
  - Tests:
    - Foam and Dome Test: Stand with eyes open, then closed, then with a dome/eyemask on a firm surface. Repeat this on a foam cushion.
  - Training:
    - Reduce visual support by closing eyes or wearing prism glasses.
    - Reduce somatosensory cues by narrowing base of support, standing on foam, or marching on a trampoline.
Functional Tests:
- Timed Up and Go: Get up from a chair, walk around a cone, and sit back down as quickly as possible.
- Berg Balance Scale: Assesses functional balance.
- Four Square Step Test: Complete a circuit by stepping into each square clockwise and counterclockwise as quickly as possible.
- Dual Tasking Activities: Standing on one leg while counting backward, marching on the spot while naming objects in a category.
- Help with fear of falling: Multi-directional step-ups, lunges with twists, marching and catching a ball.

Muscle Performance and Resistance Training

Muscle Performance:
- Strength: Ability to produce tension and force. Focus on increasing resistance.
- Power: Strength and speed of movement, focus on increasing work performed or reducing time to produce force.
- Endurance: Sustaining low-intensity, repetitive activities over time. Focus on increasing time and number of repetitions.
Resistance Training: Dynamic or static muscle contraction resisted by manual or mechanical resistance.

Aerobic Exercise

Pre-screening: Assess for regular exercise and any underlying cardiovascular or metabolic diseases.
Warm-up: Light intensity for 5 minutes at light resistance.
Monitoring: Monitor for:
- Onset of chest pain
- Decrease in systolic blood pressure by >10 mmHg
- Excessive increase in blood pressure (systolic > 250, diastolic > 115)
- Shortness of breath, wheezing, leg cramps, lightheadedness, nausea
- Physical or verbal signs of severe fatigue

Flexibility and Stretching

Elongates muscle and increases range of motion, performed at low intensities, pulling sensation but no pain).
Contraindications:
- Recent injury/fracture that is not fully healed
- Acute inflammation (heat and swelling)
- Sharp acute pain
- Hypermobility
- Spasticity
Types:
- Static (PROM): Improves flexibility and ROM by holding the tissue past resistance for a prolonged time (each rep > 10 seconds). 15 minutes daily maintains flexibility. Progress by holding the tissue at a lengthened position until relaxation is felt.
- Cyclic/Intermittent (AROM): Short-duration end-range stretches repeated at low velocities (each cycle 5-10 seconds).
- Proprioceptive Neuromuscular Facilitation (PNF) (AROM): Incorporates active muscle contraction into stretching (each cycle 10 seconds hold, 3-4 sets).
  - Types:
    - Hold-relax/contract-relax: Lengthen target muscle to resistance, perform an isometric contraction, relax, then move limb into new range.
    - Agonist contraction: Concentric contraction of the opposing muscle, hold end-range position for several seconds to allow affected muscle to relax and lengthen.
    - Hold-relax with agonist contraction: Move tissue to resistance, isometric contraction, relaxation, and concentric contraction of opposing muscle.
- Ballistic (AROM): Rapid, forceful intermittent stretches at high velocity and intensity (quick, bouncing movements). Mainly for young, healthy, and conditioned individuals at end-stage rehab.

Open Kinetic Chain and Closed Kinetic Chain

Open Kinetic Chain (Non-weightbearing): Distal segment moves freely without causing simultaneous motion in adjacent joints. Focuses on single joint movement.
**Closed Kinetic Chain (Weightbearing):**Distal segment is fixed or in contact with a support surface. Focuses on joint compression and are more functional.

Exercise Prescription Following Injury

De-sensitisation and reducing overall load is important in the acute phase of injury.
Informed reassurance and education should be provided to the patients.
Pain management is crucial and can be monitored using the pain and activity traffic light system.
- Green: 0-3 pain, safe zone.
- Yellow: 4-5 pain, acceptable range.
- Red: 6-10 pain, excessive/stop zone.
Pain should settle within 24 hours of the activity.

Exercise Prescription for OA Patients

For hip OA, isometric quadriceps contraction can be done.
- Dorsiflex the foot and ask the patient to push downwards towards the bed for 5 seconds.
- 10 repetitions should be performed.
Bridges, ensure exercise is done till muscle fatigue for actual strengthening.
- Progression: Bringing one leg up and elevating it before bringing it back down.
- Progression: Putting a ball under the leg that is resting on the bed and carrying out the exercise.
Squats should be done ensuring the back is straight and the knee goes over the toes.

Exercise Type - Grade 2 Strength

Hip Flexion: While lying supine use a polished board with knees bent and a rolled towel under the heel, move the board towards the buttocks.
Hip Extension: While lying supine use a polished board with knees bent and a rolled towel under the heel, move the board away from the buttocks.
Hip Abductors: While lying supine, use a polished board with knees bent and a rolled towel under the heel, Move the board from side to side.
Hip Adductors: While lying supine, use a polished board with knees bent and a rolled towel under the heel, move the board from side to side.

Exercise Type - Grade 3 Strength

Stretches: Static = lying supine with one leg leaning against the wall, push the leg into the wall for 30 seconds.

Exercise Type - Grade 2 Strength

Knee Flexion (Hamstrings): Leg curls in prone
Knee Extension (Quadriceps): Sit to stand

Exercise Type - Grade 3 Strength

Knee Flexion (Hamstrings): Squats, Lunges, Step-ups, Seated Marches, Seated Leg Extensions
Knee Extension (Quadriceps): Seated heel-toe raises

Exercise Type - Isometric Exercises

Wall sits
While seated place a towel under the knee with the heel still on the bed and squeeze the quads for 5 seconds before releasing.
Physio can place their hand on the towel to see if it's squeezing.
Progression: When there is no pain/exercise done with ease.

Exercise Type - Grade 2 Strength

Knee Flexion (Hamstrings): Static = lying supine and wrapping a towel under the arch of the foot, pull on the towel for 10 seconds.

Exercise Type - Grade 3 Strength

Knee Flexion (Hamstrings):
- Progression: Cyclic/dynamic leg swings (only when pain is completely gone).
- Cyclic: In tandem, the knee in front should be straightened and the back knee should be slightly bent and bend the upper body holding it for 5 seconds.
- Ballistic: Doing the same as cyclic but doing it rapidly by pulsing downwards without holds.

Exercise Type - Grade 3 Strength

Knee Extension (Quadriceps): Static = lying supine with one leg leaning against the wall, push the leg into the wall for 30 seconds.

Exercise Type - Grade 3 Strength

Knee Extension (Quadriceps):
- Cyclic: Lying prone lift the leg towards the butt as much as possible for 5 seconds before relaxing.
- Progression: Putting a pillow under the knee.
- Regression: Putting a pillow under the pelvis.

Exercise Type - Grade 2 Strength

Shoulder Flexion: Placing a slider under the affected arm, try to move the hand away from the body and use the unaffected arm to pull it further.

Exercise Type - Grade 3 Strength

Shoulder Flexion: While sitting, the patient actively lifts their arm and the physio will provide assistance to elevate their arm and slowly lower them.

Exercise Type - Grade 2 Strength

Shoulder Extension: Sitting sideways, place the affected arm on the surface with a slider underneath and slide it further out towards the side letting the unaffected arm guide the movement.

Exercise Type - Grade 3 Strength

Shoulder Extension: While sitting, the patient will actively abduct their arm and the physio will provide assistance to move the arm outwards.

Exercise Type - Grade 2 Strength

Shoulder Abduction: While sitting, the patient actively abducts their arm and the physio will provide assistance to move the arm outwards.

Exercise Type - Grade 2 Strength

Shoulder Adductors: Placing a slider under the affected arm, try to move the hand away from the body and use the unaffected arm to pull it further.

Exercise Type - Grade 3 Strength

Shoulder Adductors: While sitting, the patient actively lifts their arm and the physio will provide assistance to elevate their arm and slowly lower them.

Exercise Type - Grade 2 Strength

Elbow Flexion (Biceps): None specified

Exercise Type - Grade 3 Strength

Elbow Flexion (Biceps): None specified

Exercise Type - Grade 2 Strength

Elbow Extension (Triceps): None specified.

Exercise Type - Grade 3 Strength

Elbow Extension (Triceps): None specified.

Exercise Type - Grade 2 Strength

Elbow Flexion (Biceps): None specified.

Exercise Type - Grade 3 Strength

Elbow Flexion (Biceps): None specified.

Exercise Type - Grade 2 Strength

Elbow Extension (Triceps): None specified.

Exercise Type - Grade 3 Strength

Elbow Extension (Triceps): None specified.

Stretches For Elbows

Ballistic: Cross-body arm swings. Standing hip-width apart, extend the arms outwards and swing both arms across the body rapidly touching the opposite shoulder.

Squats

If knees buck inwards, make the BOS narrower.
Regression (especially if they have poor ankle mobility/cannot maintain an upright posture).
- Place small plates under the heel and also promotes a vertical torso.

Facilitating Trunk Awareness

Early Phase: Learning neutral positions and those of bias and those causing the most symptoms.
- Head/Upper Neck: Cervical retraction/protraction.
- Lower Neck/Upper Back: Stand against a wall/flat surface and look at their posture.
- Lower Back: Pelvic tilts.