Understanding Complex Systems

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Questions and Answers

What is the main challenge when working with complex systems?

  • Ensuring that all parts are compatible
  • Adding more components to increase functionality
  • Understanding the individual components
  • Predicting the behavior of the system as a whole (correct)

Which factor is least likely to affect system performance?

  • The color scheme of the interface (correct)
  • Network connectivity
  • The adaptability of the components
  • The speed of data processing

Which of the following best describes an emergent property in systems?

  • A trait that only applies to physical systems
  • A characteristic that diminishes with complexity
  • A property that can be observed in isolated components
  • A feature that arises when components interact (correct)

What typically happens when a system becomes too complex?

<p>It may exhibit unpredictable behavior (D)</p> Signup and view all the answers

Which method is least useful for analyzing complex systems?

<p>Reductionism (A)</p> Signup and view all the answers

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Study Notes

Range of Motion (ROM)

  • Range of motion is the amount of movement at each joint in specific directions, or the range a body part can move around a joint.
  • It's a fundamental technique used for:
    • Assessing movement (Goniometry).
    • Initiating therapies.
  • Intrinsic Factors:
    • Shape and congruence of articulating bony surfaces.
    • Flexibility of the joint capsule, ligaments, and other connective tissues.
    • Strength and flexibility of the muscles acting on or crossing the joint.
  • Extrinsic Factors:
    • Aging: reduces joint ROM.
    • Body segment size: impacts muscle/fat bulk.
    • Effects of disease, injury, overuse, and immobility on the joint tissues and ROM.

Types of ROM Exercises

  • Passive ROM (PROM)
  • Active ROM (AROM)
  • Active-Assistive ROM (A-AROM)

Passive ROM (PROM)

  • Definition: Movement of a body segment within its unrestricted range of motion (ROM) entirely by an external force, with no voluntary muscle contraction from the patient.
  • External Force Sources:
    • Gravity.
    • Machines (Continuous Passive Motion - CPM).
    • Another individual.
    • Another body part of the individual.

Types of External Forces

  • Manual:
    • Therapist.
    • Patient's unaffected body part.
    • Gravity.
  • Mechanical:
    • Continuous Passive Motion (CPM).

Uses of Passive Range of Motion

  • Relaxed Passive Movement: Maintains full unrestricted ROM.
  • Passive Movement for Mobilization: Breaks down adhesions, increasing ROM.
  • Passive Movement for Stretching: Lengthens shortened soft tissues, improving joint range.

Indications of Passive Range of Motion

  • Coma.
  • Paralysis.
  • Immobilized joint.
  • Muscle re-education (teaching desired movement).
  • Before passive stretching techniques.
  • Examinations.

Goals for PROM

  • Decrease immobilization complications (e.g., cartilage degeneration, adhesions, contracture formation, sluggish circulation).
  • Maintain joint and connective tissue mobility.
  • Minimize contracture formation.
  • Maintain muscle elasticity.
  • Assist circulation and vascular dynamics.
  • Enhance synovial movement for cartilage nutrition.
  • Decrease or inhibit pain.
  • Assist the healing process after injury or surgery.
  • Maintain patient awareness of movement.

Limitations of Passive Motion

  • Does not prevent muscle atrophy.
  • Does not increase strength or endurance.
  • Assists circulation to the degree of active, voluntary muscle contraction.

Precautions and Contraindications to PROM Exercises

  • Motion disruptive to healing process (e.g., unhealed fracture, open wound).
  • Excessive/improper movement causing pain and inflammation.
  • Effusion and swelling sites.
  • Immediately after ligament/tendon tears.
  • Uncontrolled high blood pressure.

Principles and Procedures for Applying ROM Techniques

  • Examination, Evaluation, and Treatment Planning:
    • Taking patient history (patient and relative input).
    • General examination (including active ROM, passive ROM, muscle strength).
    • Choosing appropriate techniques (AROM, PROM, AAROM).
  • Re-evaluation: Reassess and modify the intervention as needed.
  • Monitoring the patient:
    • Assess the patient's response to exercise (before and after).
    • Monitor vital signs, pain, ROM, movement quality, warmth, and skin color.
  • Document and communicate findings and intervention:
    • Note the observed pattern of applying ROM techniques such as single, combined, or functional patterns.

Patient Preparation

  • Communicate with the patient.
  • Remove restrictive clothing, splints, and dressings from the affected area.
  • Cover the unaffected parts of the body.
  • Position the patient comfortably with proper body alignment and stabilization, allowing for full ROM.
  • Position yourself for proper ergonomic practices.

Application of Techniques

  • Grasp extremities proximal and distal to target joint for control, firm but non-harmful grip.
  • Support areas of poor structural integrity (hypermobile joints, recent fractures, paralyzed limbs) to promote relaxation and confidence in the patient.
  • Move the segment smoothly and rhythmically through full pain-free range of motion, to point of tissue resistance.
  • Perform with 5-10 repetitions, adjusting based on individual needs and the response to treatment.
  • Follow established rhythmic and regular patterns.

Characteristics of Relaxed Passive Movement

  • Slowly.
  • Rhythmically.
  • Regularly.
  • Through the full available ROM.

Active Movement (ROM)

  • Movements performed within the unrestricted range of motion.
  • Controlled by voluntary muscle contractions.

Classification of Active Movement

  • Free Exercise: Working muscles are solely under the influence of gravity.
  • Assisted Exercise: Used when muscle strength is insufficient, external force (manual or mechanical) provides assistance.
  • Resisted Exercise: External forces (manual or mechanical) increase resistance against the working muscles to build strength and endurance.

Active-Assistive ROM (AAROM)

  • Performed within unrestricted ROM.
  • Voluntary muscle contractions provide most of the movement.
  • Outside force (manual or mechanical) assists as needed when muscle strength is limited.
  • Muscle grade less than 3 on manual muscle testing.

The Principles of Active Assisted Exercises

  • Insufficient voluntary muscle contraction to control movement.
  • External force to complete the range.
  • Force application in the direction of muscle action.
  • Force to augment, not replace, muscular action.
  • Assistance decreases proportionately as muscular power increases.

Types of Assistance

  • Manual Assistance: Assistance provided by another person.
    • Therapist.
    • Patient's sound limb.
  • Mechanical Assistance: Assistance provided by equipment.
    • Wand or T-bar.
    • Finger ladder, wall climbing, ball rolling.
    • Pulleys.
    • Skate board/ powder board.
    • Reciprocal exercise devices.

Effects and Uses of AAROM

  • Strengthens when the patient has weakness (but not paralysis).
  • Maintains physiologic elasticity and contractility of participating muscles.
  • Helps sensory feedback during neuromuscular re-education.
  • Provides stimulus to bone/joint integrity.
  • Facilitates coordination and motor skills for functional activities (repetitive assisted exercises).
  • Enhances patient confidence and cooperation.
  • Prevents deep vein thrombosis (DVT).
  • Improves blood circulation.
  • Enhances metabolism and reduces stress/pain to aid weight loss.
  • Reduces risk of heart disease/heart attack.

Contraindications of AAROM

  • Gross swelling/inflammation.
  • Recent myocardial infarction.
  • Severe pain.
  • Cardiopulmonary dysfunction.
  • Unhealed fractures/recent surgeries.
  • Acute tendon/ligament tears.
  • Deep vein thrombosis (DVT).

Indications of AAROM

  • Muscle weakness (disuse/after cast).
  • Muscle re-education.
  • Inability to complete activities of daily living (ADL).
  • Improving ROM.
  • Post-tendon/muscle transplantation.

Precautions for ROM Exercises

  • Perform exercises proximal and distal from the injury/immobile joint to minimize venous and thrombus formation.

Technique of Assisted Exercise

  • Starting position: Ensures patient attention and the appropriate effort for the exercise.
  • Pattern of movement: Explained by performing passively/actively on a healthy limb.
  • Fixation: Proximal fixation of prime movers improves their efficiency and prevents undesirable movements.
  • Support: Supporting the moved body part (by pillows, boards, slings, or therapist's hands) reduces load on muscles, making the exercise easier.
  • Traction: Pre-stretching of the weak muscle stimulates contractions via a myotatic reflex.
  • Antagonistic Muscle: Selecting a starting position that reduces antagonistic muscle tension.
  • Assistance force: Applying force in the direction of movement, adapting to different parts of ROM, to start, support and finish a movement.
  • Character of movement: Smooth and rhythmic, focusing on efficient and consistent movement.
  • Repetitions: Number of repetitions based on patient condition and fatigue rate.
  • Patient cooperation: Encouraging maximal effort during the workout to aid in success.

Active Free Exercise (AROM)

  • Exercises performed using the patient's muscles without assistance or resistance, other than gravity.
  • Types of AROM:
    • Localized: strengthening specific muscle groups.
    • Generalized: utilizing many muscles throughout the body.

The Principles of Active Free Exercises

  • Relaxation: Using rhythmic or pendulum-like exercises.
  • Joint mobility: Maintaining normal range of motion through the complete range (exercises performed fully).
  • Working muscle power/endurance: Building strength and endurance.
  • Coordination: Improving the coordination of muscles.
  • Confidence: Building confidence in the patient.
  • Circulatory/respiratory co-operation: During prolonged exercise, respiration will become more intense.

Goals for AROM

  • Maintain physiologic elasticity and contractility of participating muscles.
  • Provide sensory feedback from contracting muscles.
  • Provide stimulus for bone and joint integrity.
  • Increase circulation and prevent thrombus formation.
  • Develop coordination.

Technique of Active Free Exercise

  • Starting position: Efficient posture is a key for effectiveness.
  • Speed: Adjustment based on desired outcome.
  • Duration: Patient's capacity is guiding factor, stopping short of fatigue.
  • Demonstration/guidance: Demonstrating and guiding patients to perform movements.

Passive vs. Active ROM

  • Passive ROM primarily stresses the ligament/joint capsule complex (stretching and/or compression).
  • Active ROM stresses both the mover muscles and the ligament/joint capsule complex (muscle contraction creates the movement.
  • Pain generation in active ROM is an indicator for musculoskeletal injury.
  • Active ROM is useful as an initial screening for soft tissue injuries.

Manual Resistance

  • Only mover musculature is stressed – no external force, maintaining the isometric contraction.
  • Pain may occur if mover muscles/tendons are damaged.
  • Ligaments and joint capsules are not impacted due to no active movement.

Effects of Immobilization

  • Fractures, surgery, paralysis, muscle spasticity, various forms of arthritis, even pain can result from extended periods of immobilization.
  • Loss of bone density: Reduced muscle contraction/weight-bearing forces can result in delayed/incomplete recovery of bone mass/volume/strength.
  • Articular Cartilage: Reduces thickness, stiffness; diminishes ability to absorb/dissipate joint forces without injury.
  • Collagen tissue fibrosis/adhesions: Caused by excessive collagen fiber cross-links.
  • Muscle tissue atrophy/contracture: Leads to reduction in muscle size and force. Slow-twitch fibers impacted more than fast-twitch.

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