Physio All MCQs Compiled.pdf

Doc name - Phsysio MCQ’s Final Pages 1-3 1) Which of the effects of local application of heat: - Anti-edematous - laser light - Spasmolytic - Pain-relieving - Anti-inflammatory in acute inflammation -laser light - contraindicated? Done by UHF - Increases in extensibility of tissue. 2) Active kinesiotherapy includes: - Traction therapy - Massage - Terrain treatment - Occupational therapy - Mechanotherpy - Suspension therapy - Manual therapy 3) Contraindications for traction therapy are: - Disc herniation - Spinal tumor - Osteoporosis - Nerve root compression 4) Goniometry is used to measure: - Spasticity - Length of limbs - Range of motion of joints - Muscle strength - Muscle weakness - ADL 5) Which type of light is used to treat jaundice of the newborn: - UVB light - UVC light - Infrared light - Visible red light - Visible blue light - Visible yellow light 6) Which statements about the biodose are correct: - It is measured in minutes - It is measured in centimeters - mins - Used to define the dose for treatment with quartz lamp - from 50 cm - Used to define the dose for application of sollux lamp -infrared - It should be assessed immediately -after 2-6 hours - It should be assessed after a latent period. 7) Indications for cryotherapy include: - Acute inflammation of a joint. - Peripheral nerve damage - Ankle sprain - Raynauld’s disease - Posterior elbow dislocation 8) Which statement about erythema caloricum are correct : - It is a result of the application of UV (ultraviolet) light - It is homogenous with clear margins - It is non-homogenous with unclear margins - Appears immediately - Appears after a latent period - Lasts for days - Lasts for minutes - It is a result of the application of IR (infrared) light 9) The specialized system for neurodevelopment of prf. Gacheva is mainly used for: - Patients with cerebral palsy - Post-stroke patients - Patients with birth trauma of brachial plexus - Patients with multiple sclerosis - Patients with peroneal nerve paralysis 10) Contraindications for Low-level Therapy (LLLT) include: - Skin cancer - Open wound - Pacemaker - Epilepsy - Malignancy - Metal implants - Tattoos Bg colloq translated 1) Erythema caloricum is a visible change in the skin, which is observed when exposed to: It is mandatory to respond. With several choices (2 points) - UVL - IFL - VL (Visible light) - In none of the above (erythma caloricum - infrared , visible) 2) Before work the paraffin is heated to: It is obligatory to answer. With once choice (1points) - Low heat - Water bath to a temperature of 42 degree C - Water bath to a temperature of 55 degree C (Melting point of paraffin 52-53 degrees) 3) Respiratory kinesiotherapy is a mandatory component of the rehabilitation program of children with:It is mandatory to answer. With one choice (1 points) - Scoliosis - Cystic fibrosis (respiratory kinesiotherapy helps to eliminate excess secretions in the airways, helps to reduce symptoms associated with bronchial compression such as wheezing and coughing) - Development delay 4) Mark the wrong statement: it is obligatory to answer. With once choice. (1 points) - When conducting ordinary baths on the skin, a water-salt mantle is formed. - Carbon dioxide baths are gas baths - hot mineral water saturated with carbon dioxide - The different temperature of the water in common baths is 35-37 degree C - The factors through which mineral water acts are thermal, mechanical and chemical 5) Manual vertebral therapy is a method of treatment of: it is mandatory to answer. With one choice (1 point) - Disc herniation - Spondylarthrosis - Functional blockade of the intervertebral joints (to detect & remove functional blockages between the intervertebral & sacro-iliac joints. Contraindications when here are signs & symptoms of disc herniation & in case of osteoporosis.) Pages 4-6 6. The classical massage is not done when: It is obligatory to answer. With one choice. (1 point) A. peripheral nerve damage B. stroke C. inflammation of the skin (contraindications of massage; malignancy, Thrombus, Ath erosclerotic plaques, Infected tissue, areas of trauma/recent bleeding, open wound, severe varicose veins, acute phlebitis, severe osteoporosis; Relative: severe tissue that is not fully healed, receiving anticoagulant, calcified soft tissues,skin grafts, atrophic grafts, acute inflammatory conditions) D. comatose states 7. Hydrotherapy is: It is obligatory to answer. With one choice. (1 point) A. Healing method of physical therapy, which uses the healing effect of ordinary water B. Healing method of physical therapy, which uses the healing effect of mineral water -balneotherapy C. Healing method of physical therapy, which uses the healing effect of ordinary and mineral water 8. Which of the listed types of rays have bactericidal action? It is obligatory to answer. With one choice. (1 point) A. UV A (pigmentogenous effect - stimulates synthesis of melanin) B. ICL C. VL (hyperemia, trophic effect, anti-inflammatory, muscle relaxing, decrease in bilirubin, stimulating endocrine function) D. UV B (erythemic effect) E. UV C (carcinogenic and anti-bacterial effect) 9. Active kinesitherapy includes: It is obligatory to answer. With several choices. (2 points) A. occupational therapy B. extension therapy (Traction/extension therapy - Passive) C. field treatment (Terrain?) D. manual therapy (passive kinesitherapy) 10. Psamotherapy is a healing method in which the following is used: It is obligatory to answer. With one choice. (1 point) A. thermogel B. sand* C. paraffin D. cal E. ice blocks 1. The application of microwave diathermy in the oral cavity is characterized by: (2 Points) [Dental ques] A. Analgesic effect. B. Slow down the blood and lymphatic circulation. C. Increased excitability of oral tissues. D. Anti-swelling effects. E. Acceleration of epithelialization. 2. The Argon lasers? (2 Points) [Dental ques] A. Yield high intensity visible red light. (produces high intensity visible blue light) B. Curing of dental restorations. C. Changes the surface chemistry of both enamel and root surfaces dentine. D. Removes extrinsic and intrinsic stains. E. Bleaching of teeth. 3. In which of the following conditions the therapeutical ultrasound is contraindicated: (2 Points) [Dental ques] A. Intolerance to ultrasound. B. Purulent periodontitis. C. Hemorrhagic gingivits. D. Is contraindicated in all of the above mentioned conditions. (?) E. Is indicated in all of the above mentioned conditions. Pages 7-10 4. The antimicrobial effects of ozone are based on? (2 Points) - Its action on cells by damaging its cytoplasmic membrane due to ozonolysis of dual bonds. - Endogenous heat. - It stimulates tissue release of histamines and acetylcholine. - The increase of blood and lymphatic flow. - Photochemical: effects. 5. The low-energy laser beam can penetrate: (2 Points) - 2.5-3.5 cm: google says ≤5cm - > 10 cm. - not earlier than 1 week after trauma. - To overcome the motor deficit & maintain the trophics => electrostimulation Low-frequency currents with parameters depending on the results of electrodiagnostics: pulses with slowly rising forefront; 200-600 ms duration; pause 2-3-6 times longer than the pulse; very low frequency (0.25-0.5 Hz). - To maintain trophics in the affected muscles => thermal applications; paraffin; mud applications; thermogels (Taken from essays. All these modalities can be used in/indicated in peripheral nerve damage…) 26. Appliances for high- fequency currents are built on the principle of a. Oscillating circle b. Reverse piezoelectric effect c. Magnetron 27. Write down 3 indications for applying heat therapy Taken from essays. Pick 3? Paraffin - Muscle spasm, cicatrix, chronic joint diseases, slow-healing wounds/edges Sauna - Mild hypertension, neurosis, migraine, sinusitis, bronchitis, obesity, dermatitis, Lye - Arthritis, neuritis, rheumatic diseases, muscle spasms after stroke, psoriasis, gingivitis Cryotherapy? - Local pain, acute trauma, muscle spasms Heat therapy e.g Sulux + infra-rouge - pain + muscle spasm e.g non-complicated nephrolithiasis, acute gallstone diseases, scoliosis Obesity - Sauna therapy as general heat therapy - stimulates metabolism of fats, protein and carbohydrates Local paraffin application - soften tendons, accelerate recovery in Trigger finger Local application e.g. Sulux lamp - stimulates tropics + stimulates the recovery of peripheral nerves (peripheral/nerve damage) 28. Ultrasound generators are built using which principle a. Oscillating circle b. Reverse piezoelectric effect c. Magnetron 29. Thermal effect is typical for a. Interferential currents b. Microwaves -localised application (centimetric waves) - strong thermal and anti-inflam. c. Galvanic currents d. Ultra-high frequency currents 30. Write down 3 electrical currents, which require usage of hydrophilic pads during application Galvanic current Low frequency current Medium frequency current 31. Which of the following is not typical for interferential currents a. Deep thermal effect b. Analgesic effect (90-100Hz diff) c. Stimulation of bone healing (90-100Hz diff) 32. Write down the dosages for high frequency currents 1. Athermal/ - No sensation of heat 2. (low): /Oligothermal/ - Mild heating sensation 3. (medium): /Thermal/ - Moderate (pleasant) heating sensation 4. (heavy): /Hyperthermal/ - Vigorous heating that is tolerable below the pain threshold In acute process - lower doses In chronic process - higher doses 33. Improvement of muscle trophic is achieved by CHECK 1)Currents diadynamic,interferential,microwaves(decimetre) 2)Visible light, IF 3)Heat 4)Laser a. Interferential currents? b. D’arsonval? c. UHFC? To relieve pain & improve the tropics - Iontophoresis with Novocain - TENS therapy & low-frequency pulsed currents - Medium- frequency currents - Low frequency pulsed magnetic field - Phonophoressi with NSAIDs gel 34. Which electrical currents are indicated after a fractures with inserted metal osteosynthesis CHECK a. MFC - Interferential currents- defo b. ? LFPMF?? c. ? Diadynamic? Test A 1 1.Low frequency currents are up to (1) a. 100Hz b. 1000Hz LFC: 0-1000Hz MFC: 1000-100,000Hz HFC: >100,000Hz 2. Anti inflammatory effect is from (1) a. Interferent current b. High frequency (Ultra high has anti inflammatory,- subtype of HFC) c. Galvanic d. Micro waves :this is a type of HFC, pick HFC as choice to be on safe side 3. To make an electrophoresis is it preparation to be known (3) a. What is the charge of the active substances b. Active substances to be used in in a solution c. The characteristics of the current d. It doesn’t matter 4. For low frequency is not typical (1) a. Thermal effect b. Stimulating effect c. Analgesic effect 5. Modulated neo-foederic currents is used for (1) Think it’s supposed to say Neo-faradic current a. Stimulation of the hypotrophic muscles (If this is the same as Sinusoidally modulated???) b. Stimulation of the muscle with damaged nerves -neuritis,radiculitis c. Weak abdominal nerve 6. For electrophoresis on the positive electrode were (1) a. Sol nivaline Others: Lidocaine (+) b. Sol Kl c. Sol glocode d. Sol Na -negative 7. Fibrinolytic effect is typical for a. Ultrasound b. Interferential c. High frequency 8. Neuefes current are a. High frequency b. Interferential currents 9. Excitometric currents (lecture) a. Classical electrodiagnostic b. Ultrasound therapy c. Electromyographic diagnosis 10. Write the wavelength for microwaves for decimetric and Centrimetric Decimetric-Wavelength 69cm or 64cm Frequency 433.92MHz. Centimeter-Wavelength 12.2sm, 12.4sm,12.6sm Frequency 2490MHz 11. Write the parameters for stimulation of muscles with peripheral nerve damage Current with slowly increasing forefront- triangular or exponential is used. - Duration of pulse = 50-100-200 ms. (partial) or 300-500ms (complete) - Duration of the pause is 3-6 times longer than the pulse. - Frequency: 0.25-0.5 Hz. The intensity of the current used is enough to provoke contraction. - Duration of application: 3-6 mins. 12. Nerve missing - Waller degeneration Marked atrophyDecrease in metabolic activity Degeneration of muscle fibres, breakage of sarcoma Increase of connective tissue and fat Increased risk of decubital ulcers Poor excitability 13. Write examples for usage of magnetic field therapy with physical factors -Accelerated bone healing and remodeling -Activation of cell metabolic chain via irritation of cell membrane -Better blood supply -Important during immobilization when gravity and movement stimulation is missing! -Increase in growth factors -Increase in mineralization, angiogenesis, collagen production -Stimulated endochondral ossification -Myorelaxation and spasmolytic effects, perfusion enhancement, Ca2+ eflux -Anti Inflammatory & anti swelling effects- phagocytes activation -Nerve tissue healing and repair acceleration 14. Write 5 diagnosis for the use of lidocaine with electrophoresis -De Quervain Syndrome -Trigger finger -Disc herniation -Haematomyelia (1st stage) -Spondylosis -Ankylosing spondylitis -Peri arthritis -Epicondylitis -Tendovaginitis Test B 1. Medium frequency currents are a. Up to 1000Hz : LFC b. 1000-100,000 c. Above 100,000 : LFC For the stimulation of hypotrophy of the muscles we use a. + electrode b. Electrode? For low frequency is not typical a. Thermal effect : in HFC b. Analgesic effect c. Stimulating Foredeu cage is used for protection from = Faraday cage a. Laser therapy b. Pulse magnetic field c. High frequency current (Ultra high frequency) A Faradic type current is a short duration interrupted DC with pulse duration of 0.1-1 ms and a frequency of 50-100 Hz The hroroactive? is prolonged = Maybe hypotrophic??? a. For peripheral paralysis? b. Hypothermic c. Depression Sinusoidal modulated currents are a. Modulating fading currents b. Currents for pulsaive galvanisation c. Medium frequency currents modulate with low frequency currents Medium frequency currents are a. Have trophic effect b. Stimulation of muscles c. Analgesic effect Emitters for ultrasound are on the basis of a. Oscillating b. Reverse piezoelectric c. Direct piezoelectric Emitters for high frequency currents are on the base of a. Oscillating currents b. Reverse piezoelectric c. Direct piezoelectric The safety from high frequency current emitters are on the basis of: a. Ultra high ????? i. Capacitor electrodes hard and soft ii. Induction electrode cable and solenod Decimeter waves, emitter: i. Round ii. Linear iii. Scaphoid Centimeter waves emitters: Circular, Rectangular, applyied by contact,focused Pages 29-32 Α 1. Which modality of diadynamic currents could be used for simulation of hypotrophic muscle with normal innervation: Rhythm syncopy:1s monophase & 1s pause 2. Defining individual skin sensitivity is required when we apply UV light therapy and is measured by BIODOSE. Biodose: the minimum duration in minutes necessary to cause the slightest hyperaemia with clearly defined margins after exposure of 50 centimetres distance 3. Classic electro-diagnostics is performed in patients with a. spastic paralyses b. peripheral nerve damage (Pheripheral nerve damage → accurate diagnosis by EMG & CED) c. hyptrophic muscles 4. Write down 3 types of specialised kinesiotherapy techniques (neurodevelopmental) 1. System of KABAT 2. System of BOBATH 3. System of VOJTA 4. System of Prof Gacheva 5. Which physiological parameter corresponds to the intensity of current used in electrical stimulation: a. Chronaxia = t Impulse b. rheobase c. ability to accommodate = refractory period (t pause) 6. Write down 3 indications for sauna therapy 1. Degenerative joint disease 2. Obesity 3. Diabetes 4. High blood pressure 5. Migraine 6. Sinusitis and bronchitis 7. Dermatitis 7. Write down the main principles of medical rehabilitation 1. Individual approach 2. The patient should be an active participant 3. Rehabilitation should start on time 4. The goals should be clear and well planned 5. Systemic and continuous 6. Rehab must comply with the rehabilitation potential of the patient 8. Infrared light has following effects: a. thermal b. photoelectrical c. photochemical 9. The most important effects of galvanic currents are observed in a. polar zones: location where compound is formed b. peri-polar zones location with specific effects c. inter-polar zones location with non-specific effect 10. High frequency currents are: a. D’Arsonval b. interferential currents : MFC c. sinusoidal modulated currents : MFC MFC: D’arsonval, Ultra high FC (short wave diathermy), microwave therapy (decimeter & centimeter waves) 11. The root syndrome includes: Root syndrome: pain, increased/ decreased sensibility and reflexes, positive streching symptoms-Lasegue, Bonne 12. Post-isometric relaxation is (underline) active/passive/ Active+passive kinesiotherapy (if it asks for 1, it is under Passive KT maybe) 13. Write down the important elements of dosage of terrain treatment Speed of walking Inclination Number of rests Duration of pause 14. The shape of the pulses used for electrostimulation of muscles with preserved peripheral innervation is triangular or rectangular 15. Manual therapy is mostly used for: To detect & to remove functional blockages between the intervertebral & sacro-iliac joints. In breast cancer after removal of LN 16. Write down rehabilitation program for patients with gonarthosis: Gonarthrosis=Knee osteoarthritis (i) Muscle strengthening exercise: This includes: - Resistance exercise: High intensity training greater than 70% of 1 RM. (ii) Aerobic exercise: High & low intensity (iii) Balance training: Postural stability is improved by aerobic walking & strengthening exercises. (iv) Whole body vibration, balance exercises, Thai Chi (v) Manual mobilization & Post-isometric relaxation (PIR); stretching 17. Write down 3 physical factors, which could decrease spasticity: Heat Cryotherapy LFC 18. Write down 2 CI for starting rehabilitation after myocardial infarction; Unstable angina Thrombophelbits 19. Write down a rehabilitation program in case of peripheral nerve damage; Peripheral nerve damage (flaccid paralysis) - Iontophoresis with Nivalin to improve neuromuscular conduction. - Electrostimulation of the muscles. - Thermal appliances - Kinesiotherapy => position therapy (for the prevention of contractures); trophic massage; analytical exercises to improve strength & trophics of the muscles. To stimulate the recovery of the nerve lesion - UV, ultrasound in low dosage (partial lesion). - Short- wave diathermy => not earlier than 1 week after trauma. - To overcome the motor deficit & maintain the trophics => electrostimulation Low-frequency currents with parameters depending on the results of electrodiagnostics: pulses with slowly rising forefront; 200-600 ms duration; pause 2-3-6 times longer than the pulse; very low frequency (0.25-0.5 Hz). - To maintain trophics in the affected muscles => thermal applications; paraffin; mud applications; thermogels. 20. Write down 3 symptoms for patients with Bells palsy; 1. Drooling of mouth (drooping corner of mouth) 2. Inability to CLOSE the eyelid 3. Unable to wrinkle forehead 4. Loss of nasolabial fold 5. Facial m weakness to total paralysis B 1. We measure SKIN SENSITIVITY by defining the biodose in cases where we apply: UV light. 2. Write down 3 natural physical factors 1. Sun radiation 2. Climate 3. Water -ordinary and mineral 3. Write down the characteristics for low intensive LASER light: 1. Monochromatic 2. Collimation 3. Coherent 4. Polarised 4. Write down the main balneotherapy factors 1. Mineral water 2. Climate 3. Peloids 5. Which methods do we use for evaluating muscle weakness in cases with damage to the peripheral nervous system? a. Brunnstrom scale : Evaluate for motor deficiencies in stroke b. Manual muscle testing c. locomotion testing: Evaluate for motor deficiencies in stroke 6. Which physiological parameter corresponds to the duration of the pause in low-frequency currents a. Chronaxie b. rheobase c. refractive period 7. Which of the following cases are treated with electrical stimulation a. ulcus duodeni b. Bell’s palsy in acute stage c. Muscle hypotrophy 8. Appliances of high frequency currents are built on the principle of a. oscillating circle b. reverse piezoelectric effect c. magnetron 9. Write down the members of the rehabilitation team 1)PRM specialist 2)specialists from different disciplines (ex neurologist, pediatrician) 3)Physical therapist/Kinesiotherapist (ex for electrical therapy) 4)Nurse (mointor of BP, T) 5)Occupational therapist 6)Social workers 7)Patient Pages 33-36 10. Which of the following effect is not typical for low-frequency currents a. analgetic b. immune-stimulating c. muscle stimulating 11.Write down 3 indications for applying heat therapy Muscle spasm Obesity ▪ Diabetes ▪ Degen. Joint disease ▪ Stimulates immunity ▪ Beneficial to skin Peripheral nerve damage Decreased range of motion Chronic pain - Peripheral vascular conditions 12. Write down 3 CI for active kinesiotherapy DVT High BP High Fever - Respiratory problems, Skeletal diseases, Muscle weakness/muscular problems, Neurological problems 13. Write down 3 types of specialised kinesiotherapy methods: KABAT BOBAT VOJTA -Methods of Prof. Gacheva 14. Endogenous heat is typical for a. interferential currents b. microwaves c. galavanic current d. high-frequency currents (Also Ultra-high frequency, D’asrsonval) 15. Indications for D’Arsonval therapy are: a. slow healing wounds, varices b. muscle stimulations, patient with pacemakers (Pacemaker= CI) c. patients with metal osteinthesis, multiple sclerosis : Interferential ? 16. Rehabilitation program for patients with stroke consists of : Kinesiotherapy - system of kabat Positioning treatment Inhalation therapy and breathing exercises -System of Bobath, Brunnstrom, Ryazkova? Gait training, Heat therapy/electrotherapy for relaxation of rigid or spastic muscles, electro stimulation 17. Write down 3 physical factors which stimulate bone recovery: Laser Interferential current -LFPMF, Electro stimulation, 18. Which of the following effects is not typical for high frequency currents a. anti-inflmmatory b. endogenous heat c. stimulation of muscles 19. CI for hydrotherapy are (cryotherapy is used to decrease pain, hematoma, edema & spasticity) a. neuralgia b, high fever c. heart failure d. muscle spasticity 20. Write down a rehabilitation program for an 8 month old child with cerebral palsy: -PRM Therapy –during WHOLE life, start ASAP (BG: 10 times/month) - Kinesitherapy (Vojta->in the beginning of the disease to develop motor skills, Bobath after 2 years); position treatment; LFPMF;(decreases pain,m spasm, swelling) Electrical stimulations (after 6th month); (to strengthen the weak m) Hyperbaric oxygenation; (to increase O2 in blood) Thermotherapy (cryotherapy/paraffin aplications); (for m spastisity, and help to reach full motion range) Radial shock wave therapy; Hydrotherapy; -if there is NO epilepsy- to decrease m spasm Orthosis- in some cases C 1. Write down rehabilitation program for a child (5 months old) with birth trauma of brachial plexus - PRM Therapy - As early as possible (5-6 day after birth); to ragain n function, regeneration, movement MOST important=KINESIOTHERAPY Kinesitherapy (Prof. Gacheva method, Kabat); (kinesiotherapy in newborn=PASSIVE) Positional therapy, Stretching (prevent joint contracture) LFPMF; (for m spasm/n regeneration/trophics/decrease swelling) Electrical stimulations; with Low freq pulsed current (to help with n damage) Electrophoresis with Nivalin; (to help with n damage) Heat therapy (decrease m spasm/swellin 2. Ultrasound generators are built using the following principle: a. oscillating circle b. reverse piezoelectric effect c. magnetron 3. Which of the following effects are typical for low-frequency current? a. analgesic b. immune-stimulating c. production of endogenous heat 4. Which of the following methods is used for evaluation of muscle weakness in cases of damage of the peripheral nervous system? a. Brunnstorm scale b. manual muscle testing c. locomotion test 5. Write down 3 types of active kinesiotherapy Medical exercises Terrain treatment Occupational therapy Suspension and pulley therapy -Specialised systems for neuromuscular reeducation 6. Which of the following physiological parameters corresponds to the length of pulse in low frequency currents? a. rheobase b. chronaxie c. refractive period 7. Which physical factors are contraindicated for patients with pacemakers: a. low frequency currents b. Low frequency pulsed magnetic field c. Low energy LASER 8. Write down 3 modified physical factors: (Modifiable?) (So like, smoking, diet, exercise. Sex and age are non-modifiable) Age Sex Diet?? 9. The vertebral syndrome includes Scoliosis Rigidity of paravertebral muscles Pain on the affected area (of the spine column) -limited movement of segments, lack of lordosis Vertebral syndrome -lower mobility of the lower back, plane lordosis, paravertebral muscle rigidity. 10. Write down 3 therapeutic effects of low-intensity LASER light: Pain relieving, Increases angiogenesis, Increases GF response Accelerates healing time Increased circulation Decrease swelling -Supress local inflammatory reaction and fibrosis 11. Write down 3 indications for applying cryo-therapy Acute injury Decrease spasticityà in MS Reduces swelling in acute inflammation Pain relief Bleeding 12. Thermal effect is typical for? a. interferential currents b. microwaves c. galvanic currents d. ultra-high frequency currents (Both produce endogenous heat) 13. Write down 3 medical conditions of the musculo-skeletal system, for which it is appropriate to use suspension therapy Osteoarthritis Bone fracture Stroke 14. Write down 3 electrical currents, which require usage of hydrophilic pads (REPEAT) during application Galvanic current Low frequency current Medium frequency current 15. The method used for measuring the range of motion of the joint is goniometry - JOINT MOBILISATION ??? -Mannual Muscle Testing? Schober (Lumbar spine specifically) 16. Write down 3 neurological conditions in which it is appropriate to use specialised kinesiotherapy methods Cerebral palsy Peripheral nerve damage Stroke Pages 37-40 17.Write down 3 physical modalities for improving muscle trophic (REPEAT)(CHECK) - Interferential, Diadynamic, Microwaves(decimeter) - Visible light, IF - Heat, Laser 18. Write down which muscle groups form the muscle waistband? Paravertebral muscles Abdominal muscles Gluteal muscles 19. Balneotherapy is obligatory for? a. Asthma bronchiale b. Nephrolithiasis c. Ulcus duodeni d. Rheumatoid arthritis (Also Used for Gallstones, Gout, TBI and chronic rhinitis) 20. Write down the definition of rehabilitation WHO: The use of all means aimed at reducing the impact of disabling and handicapping conditions and at enabling people with disabilities to achieve optimal social integration” It is a branch of medicine that aims to enhance and restore functional ability and quality of life to those with physical disabilities. (couldn't find source of this answer so not sure if right) 1. US waves are a. monochromatic coherent light (This is a laser light feature) b. mechanical wave of pressure and displacement, through a medium such as air or water c. Electromagnetic light with frequency of 16-2000 Hz ( acoustic vibrations of high frequency (above 20 kHz)) 2. Write down the wavelength for UV light 380-180nm. (UVA 380-315nm. B 315-280nm, C 280-180nm) 3. Visible light has the following effects a. thermal b. photoelectrical c. photochemical 4. The shape of the pulses used for electrostimulation of muscle with damaged peripheral innervation is: Exponential and triangular 5. Which of the following is typical for interferential currents a. bone healing b. analgetic effect c. stimulation of bone healing 6. Write down 3 types of passive kinesiotherapy (remember there are 4 M.M.M.T) Massage Traction therapy Manual medicine Mechanotherapy 7. Write down the definition of rehabilitation WHO: The use of all means aimed at reducing the impact of disabling and handicapping conditions and at enabling people with disabilities to achieve optimal social integration” It is a branch of medicine that aims to enhance and restore functional ability and quality of life to those with physical disabilities. (couldn't find source of this answer so not sure if right) 8. Which of the following effects is typical for medium-frequency currents a. endogenous heat b. analgetic c. deep thermal effect 9. The dose used during application of low-frequency current is measured by: a. biodose b. patients sensation c. measuring the chronaxiae 10.Write down the dosages of high frequency currents Athermal – used in treating process in the brain Oligothermal–most commonly used Thermal–most commonly used Hyperthermal 11. The characteristics of the erythema, after application of infrared light are: it has vasomotor character- vasodilation of the vessels (arterial and capillary due to thermal effects of radiation) Appears immediately, disappears in a short time after the end of exposition (1/2 to 1hour) Inhomogeneous unclear margins hyperemia in remote areas 12. Write down rehabilitation program for patients with Bell’s palsy (All info this info is in the resource doc) Neck Massage-reflex response—> from 5-6th day Mimic exercise - using the techniques of PNMU / stretch, irritate / Physical agents Solux (light therapy) —> 5-14th day - blue filter; after the 14th day day - with a red filter Electrostimulation - after the 30th day, after an individual assessment Paraffin applications in cases with contractures 13. High frequency currents are a. D’Arsonval b. Microwaves c. Sinusoidal-modulated currents (high frequency currents are D’Arsonval currents, Diathermic currents, Ultrahigh-frequency currents (short wave diathermy) and Micro-wave currents ( Microwave diathermy) 14. Suspension therapy is a therapeutic method, performed a. against gravity b. in eliminated gravity (Eliminated gravity also includes underwater gymnastics) c. against resistance (This is to increase ranges of motion of muscles in eliminated gravity. There are some belts around limb of patients. Useful when there is problem with hip & shoulder joints) 15. Contraindications for US therapy are: - Around the epiphysis of the growing bone. - Directly on spine or brain (In case of disc herniation, ultrasound must be applied for 5 mins on the right side & 5 mins on the left). - Pacemaker is not a contraindication for ultrasound. - Metal implants (Ultrasound used above metal implants leads to strong thermal effect). 16. Brunnstrom scale is used for: a. evaluating spasticity b. evaluation of muscle weakness c. evaluation of recovery stage of the patient after stroke (We must determine the Brunnstrom stages/for recovery from stroke-for muscle spasticity and ADL) 17. I mprovement of muscle trophic is achieved by (please chck its in pg 128) - Ionotophoresis with Novocain - TENS therapy & low-frequency pulsed currents - Medium-frequency currents - Low frequency pulsed magnetic field -Phonophoresis with NSAIDs gel 18. In the acute phase of Algo-dystrophic syndrome (zudeck disease), it is indicated to locally apply: TENS: transcutaneous electrical never stimulation Galvanic current Magnetic field 19.Which electrical currents are indicated after a fracture, with inserted metal osteointesis 20. Write down a rehabilitation program for a patient with stroke Should focus on minimizing disability and prevention of complications such as DVT, contractures, pain, pneumonia, incontinence, sexual dysfunction, depression, spasticity, seizures etc. The rehabilitation plan is comprised on the basis of the assessment and rehabilitation potential: There Are different stages f the musculoskeletal system, so activities 1) In the acute stage we have to Prevent complications o like passive kinesiotherapy and breathing exercises are done. 2) EARLY RECOVERY PERIOD (3rd – 6th Month): Patient achieves independence in the bed, standing, walking, activities of daily living. 3) ADVANCED STAGE OF RECOVERY (6th – 18th Month) ○ - To improve independent movements in paralyzed limbs t o achieve more complex motor patterns ○ - To improve gait and fine movements This can be done via techniques like bobath and kabat. Overall Positioning: a series of positions, built on the principle of maintaining simultaneously the unity of body segments/ head/ trunk/ limb Passive mobilisation: Full amplitudes of movement in the joints, Moderate dosage of force without stretching with rapidly progressive pulling and holding the final position. Training of walking Kinesiotherapy: system of kabat Inhalation and breathing exercise Doc name - Physio BG practice open questions Page 1-4 Pages 5-8 7. The physical parameters of LFC with adjustable parameters of which physiological characteristics of electrically excitable structures meet? 8. What are the optimal parameters of LFC with adjustable parameters for electrical stimulation of intact and denervated muscles of varying degrees? Innervated Muscle: Triangular or rectangular wave, Short duration 0.2-0.5 - 1-2ms pulse, Equal pause, 30-50-80Hz Partially Denervated: Slowly rising forefront, (50) 100-200ms pulse, 1-2 - 6x longer pause, 0.25-0.5Hz Totally denervated: Slowly rising forefront, 300-400-600ms pulse, 1-2 - 6x longer pause, 0.25-0.5Hz 9. What is the physical characteristic of diadynamic currents? Diadynamic currents are monophasic pulsed currents, that have a hemisinusoidal shape, with frequency of 50-100Hz. 10.What is the physiological action of diadynamic currents? Depending on the form of the diadynamic current used they have: - Monophasic: Stimulation - Diphasic: Analgesic and sympathetolytic - Core period: Stimulate tropics and resorption of oedema - Long period: Mostly inhibition and pain relief - Rhythm syncope: stimulate muscles WITH preserved innervation TOPIC 3 Electrical treatment, medium frequency currencts (MGC), Ultrasound, aerosol and aerionotherapy. 1. What is the physical characteristic of medium frequency modulated currents? MFC are between 1000-100,000Hz. They can be amplitude modulated with a carrier frequency of 2000 or 5000Hz, or Interferential currents. 2. What is the physiological action of medium frequency modulated currents? Same physiological effects as LFC, but with reduce skin resistance and discomfort, and with deeper penetration: - Pain relief - Reduction fo oedema - Increased circulation - Muscle stimulation 3. What is the physical characteristic of interferential currents? These use 2 medium frequency currents that meet at a specific point within the tissues, to form a low frequency current at the point of crossing. 4. What are the indications and contraindications for treatment with MFC? Indications: - Osteoarthritis - Periarthritis - Bone fractures (metal implants) Contraindications: - Pacemaker - Acute inflammatory disease - Malignant tumours - Pregnancy - Haemorrhage - Acute or subacute thrombophlebitis 5. What is the physical characteristic of ultrasound? Mechanical wave with frequency above 20,000Hz. Inaudible acoustic vibrations (sound waves). 6. What is the principle of obtaining an ultrasound? (Indications?) Indications?: - Neurological disorders eg neuritis, radiculitis - Vertebrogenic eg disc diseases, spondylarthrosis - IDA eg osteoarthritis, epicondylitis, tendinitis, tendovaginitis - Traumatic eg fractures, dislocations - Peripheral vascular diseases eg Buerger, Raynauds - Internal diseases eg bronchitis, asthma, esophageal spasm, ulcer - Gynaecological eg parametritis, adnexitis - Skin eg scleroderma, atonic wounds - scarring - ENT - Dental 7. What are the main factors of action of ultrasound? Ultrasound works on the principle of Inverse piezoelectric effect. Electrical current is passed through the crystals, which causes them to vibrate at a given frequency. This sends mechanical waves into the tissue pausing pressure changes. 8. What are the biological and therapeutic effects of ultrasound? - Fibrinolytic - Reduce joint stiffness (contractures) - Increases stretchability of collagen fibres - Hyperemia and improve metabolism - Stimulate regeneration and restoration of tissues - Decrease muscle tone - Normalise vascular tone - Analgesic 9.What are the physico-chemical bases of the aerodisperse system? Related to inhalation therapy? Chemicals transformed into aerosols for inhalation, to treat respiratory conditions. 10. What types of aerosol generators do you know? - Metered dose inhaler (MDI) - Dry powder inhaler (DPI) - Spacer - Rotahaler - Nebuliser 11. What are the main properties of aerosols? Aerosols are a suspension of very fine liquiuds or solid particles in a gas. These can be inhaled into the upper or lower respiratory tract, depending on the size of the particles. 12. What is aerionotherapy? Related to climate therapy? Aerions can be positive or negative. Positive found in cities, related to pollution etc - Unhealthy? Negative are found in nature, high concentrations in certain regions. People advised to travel to these locations to be immersed in “good quality air”. This is just my waffle.... TOPIC 4 Electric treatment. High frequency currents (HFC) and magnetic field. 1. What is the principle of HFC generation? HFC are generate on the principle of oscillating circuits. The energy oscilates between electrical and magnetic energy, both of which are used for various reasons. 2. What is the physical characteristic of high frequency current? Currents over 100KHz (>100,000 Hz). Varying wavelengths depending on the frequency/type of HFC used. 3. What types of high frequency currents do you know? - D’Arsonval - Ultra HFC - Decimeter waves (Microwave) - Centimeter waves (Microwave) 4. What is the physical characteristic of D’arsonval currents? Wavelength - 1000-3000m, Frequency - 200-300KHz. High frequency electromagnetic oscillations with sinusoidal shape. Has a fading nature of fluctuations. 5. What is the therapeutic effect of D’arsonval currents? - Pain relieving - Anti itching - Hyperemia - Bactericidal - Stimulate regeneration of skin, anti aging 6. What is the physical characteristic of ultra-high frequency currents? HIgh frequency alternating currents with wavelength 11.06m and frequency of 27.12MHz. Can be applied in the form of an electric or magnetic field depending on the type of emitters. 7. What is the therapeutic effect of ultra-high frequency currents? - Anti inflammatory - Analgesic - Stimulates endocrine glands - Increases diffusion through cell membranes - Spasmolytic - Reduces joint stiffness 8. How are ultrahigh frequency currents generated? Using one of 2 types of emitters - Capacitive electrodes which create a high frequency electrical field - Inductive electrodes which use the magneticfield component 9. What is the physical characteristic of decimeter waves? Wavelength 69 or 64cm. Frequency 433.92MHz 10. What is the depth of penetration of decimeter waves? Penetrate 10cm into tissues. 11. What is the physical characteristic of centimeter waves? Wavelength 12.2cm, 12.6cm, 12.4cm. Frequency 2490MHz 12. What is the therapeutic effect of centimeter waves? - Endogenous heat production. Used for inflammatory processes. 13. What is the physical characteristic of magnetic therapy? Uses magnetic fields produced by natural sources or generated from solenoid coils (artificial source, more typical) 14.What is the therapeutic effect of magnetic therapy? - Vasodialtion - Anti oedema - Improves rheology of tissue fluids - antithrombotic - Improves tropics and stimulates tissue regeneration - Stimulates bone recovery - Analgesic - Anti inflammatory (40Hz) 15. Indications and contraindications of treatment with HFC. D’Arsonval - Pain syndromes, Vascular, wounds, stimulation of walls of veins, dermatology UHFC - Respiratory, ENT, Nervous, Musculoskeletal, Surgery, ObGyn, Vascular diseases (Look up the specific conditions) Microwaves - Decimeter for different inflammatory and cardiovascular diseases, Centimeter for more localised/near to the surface inflammatory processes. TOPIC 5 Light therapy. Sources of light energy. Dosage, methods of prevention and treatment. Lasers in Physical medicine and reflex therapy. 1. What is the physical property of light waves used for prophylaxis and treatment? Different energies of light are used for their different properties. The main physical property utilised is the differing wavelengths of light. Depending on the wavelength and subsequent position on the spectrum, light has a range of properties for prophylaxis and treatment. 2. What are the main types of caloric and luminescent light energy sources? Caloric - Solux, infrarouge, sunlight. Luminescent - Sun, Argon-mercury quartz lamp, 3.What is the biological action of visible rays? Energy is transformed into kinetic energy and produces heat. Trophic, anti-inflammatory, muscle relaxation. Local effect similar to but weaker that IR. CNS - increase psychotonus, improve mood, Regulation of endocrine function Visible Blue light - photochemical degradation of billirubin 4. What is the biological action of infrared rays? Penetrates 1-2cm Energy is transformed into kinetic energy and produces heat. Trophic, anti-inflammatory, muscle relaxation. Erythema caloricum - Vasomotor, hyperemia in remote areas, thermal effect. 5. What is the biological action of ultraviolet rays? Erythema caloricum - Vasomotor, hyperemia in remote areas, thermal effect Erythema photoelectricum - Realease of biologically active substance as a result of cellular destruction Melanogenesis - Tanning/darkening. Can cause DNA damage May lead to skin damage and peeling 6. What is the individual and regional sensitivity of the skin to UV? Individual sensitivity depends on sex, age, presence of andocrine disorders, hypertension and jaundice. Regional sensitivity is differing sensitivity on different parts of the body (Most to least): - Abdomen and lumbar area - Chest, back - Folding surfaces and extremities - Hands and feet 7. How is UV radiation dosed? Using the Biodose - minimum duration (minutes) need to cause slightest hyperema with clearly defined margins. Erythema dose - 1-5 biodoses Suberythema dose - ¼ biodose 8. What types of UV do you know? UVA - 380-315nm, UVB 315-280nm, UVC 280-180nm 9. List the features of a laser. What is the basic device of a laser? Work on the basis of stimulated emission of light. Lasers produce light that is monochromatic, coherent, polarised and collimated. Basic devices may have high or low power (up to 10mW for laser puncture or up to 25-75mW for laser therapy) The devices may have pulsed or continuous regimes. 10. Requirements for working with a laser. Safety equipment. Goggled must be worn at all times when working with lasers. 11. Indications and contraindications for the use of laser radiation. Indications: - Wounds - Degenerative + inflammatory disorders of joints, overuse syndrome - Traumatic injuries - Neuritis, herpes zoster - Skin - neurodermatitis, herpes simplex, acne - Adnexitis - Dental disorders Contraindications: - Absolute - Eye, Tumour diseases, irradiation of endocrine glands, tattoos or freckles - Relative - epilepsy, pregnancy, febrile conditions, sensational defecit, photosensitive medication Special precautions must be taken. All patients evaluated on Fitzpatrick scale - The more pigment in the skin, the higher the absorption/heating Page 9-12 ❏ Kneading(muscles) ❏ Vibrations(relaxation) ❏ Hit/strike(irritation) 3) How do the different massage techniques affect the underlying structures? a) ReflectiveKinesiotherapy: 1) Types of kinesiotherapy: This is the therapy with movements and there are two main types. Active: requires the active participation of the conscious patient who performs voluntary movements. Passive: this has 4 types: massage, Traction therapy, Manual therapy, mechano-therapy. 2) Types of active Kinesiotherapy: There are 5 types A) MEDICAL GYMNASTICS B) OCCUPATIONAL THERAPY C) TERRAIN TREATMENT D) SUSPENTIONAL & PULLEY THERAPY E) SPECIALIZED SYSTEMS FOR NEUROMUSCULAR RE-EDUCATION 3) How does kinesiotherapy affect various organs and systems: On respiratory system there is an increase in CO2 and acidosis which stimulates the respiratory centre and increases the breathing rate Nervous system- strengthening of synapses - neuroplasticity Metabolism is increased; and accelerated elimination of metabolic products by excretory system Musculoskeletal system- improves muscles metabolism, trophics, the mechanism of muscle contraction and muscle strength improves bone density and microarchitecture Improves the elasticity of the joint capsule and ligaments Theme 7: 1) What types of passive kinesiotherapy do you know: massage, Traction therapy, Manual therapy, mechano-therapy. 2) What types of therapeutic massage do you know? Effleurage(skin)-usually begin with this Rubbing(subcutaneous) 1. Improves the blood circulation, 2. Tropics, 3. Analgesia, 4. Lymphatics and metabolism b) Humoral – stimulation of forming active substances such as histamine, vitamin D c) Mechanical – stretching and drainage of fluids (anti-edema) 4) What types of reflexology do you know? Can’t find answer? 5) What functional methods for assessment of CNS, PNS, ODA do you know · System of vojta: For CNS disorders, especially for children with cerebral palsy to stimulate the normal movements of the babies by pressing specific areas around the joints. These are known as trigger zones · System of Bobath :For patients with CNS disorders — stroke, traumatic brain injuries · system of prof. Gachev: For PNS disorders, especially for babies with birth trauma of the brachial plexus · System of Kabat : Proprioceptive neuromuscular facilitation technique for PNS disorder Topic 8: Rehabilitation potential functional message on determination of rehabilitation potential. compiling of rehabilitation programme efine the term rehabilitation potential: The patient’s potential to achieve goals set by the PRM specialist. This is 1) D based on cognitive function, medical status of the patients, motivation, social support and economic resources. This can be categorised as: fair, guarded or poor I. Fair indicates the patient is able to follow the plan of care and progress towards goals. II. Guarded indicates doubt about the patient’s potential. III. Poor indicates that the patient is unable to achieve the goals 2) What functional research we use for determining the rehabilitation potential of the patient with various diseases. This is based on cognitive function, medical status of the patients, motivation, social support and economic resources. 3) What modern methods do we use to evaluate the static and locomotor imbalance 4) How are the goals of rehabilitation programme determined: Its aim is to educate the patient to perform his own profession or acquire qualification for a new profession after complex assessment and evaluation of the health condition and disability– vocational rehabilitation and return to work 5) How are the tasks of rehabilitation programme determined: 6) How are the funds of rehabilitation programme determined: Topic 9: Physio-prophylaxis physical therapy and rehabilitation of common cardiovascular non specific Pulmonary diseases endocrine gastrointestinal kidney gynaecological and oncohaematological diseases 1) Who are the goals and objectives of physical treatment and rehabilitation in patients with Myocardial infarction according to the stage of the disease process and different faces of flow. · Early and gradual mobilization · Restoration of physical work capacity and improvement of functional coronary reserve 2) What is the place of physical factors for Physio-prophylaxis uncomplex treatment of arterial hypertension Obesity is part of metabolic syndrome that causes arterial hypertension. So we can do prophylaxis of arterial hypertension by managing the risk of obesity. We do this via these methods o Kinesiotherapy: terrain type o General UV o Sauna o Solux 3) What natural and reformed physical factors apply to healing of arterial hypertension Physical factors: · we can use thermal therapy to treat arterial hypertension. · LFPMF A natural factor: that can be used to treat arterial hypertension is massage as this is indicated when there is arterial hypertension. 4) What natural and reformed physical factors are plotting complex treatment of pain with non specific lung diseases. Physical factors for pneumonia: UHF LFPMF: Low frequency pulsed magnetic frequency UV IRRADIATION Inhalation therapy with mucolytics Natural factors for pneumonia : Postural drainage, percussion and vibration massage to facilitate expectoration and Kinesiotherapy with breathing exercises 5. What are the possibilities of physical factors in the treatment of obesity, diabetes gout and the complications? Diabetes gout and obesity can be treated with sulphate waters. diabetes and obesity can be treated with UV. A complication of using excessive UV light is malignancies. For polyneuropathies (use electrophoresis (nivalin agent), electrostimulation) Diabetic foot: Use Laser (for anti-inflammatory and analgesic effect) or D’arsoruval (which improves blood flow and anti inflammatory) obesity: Sauna, General UV Gout: Cryotherapy used in acute stage and for the remission stage use balneotherapy 6) What is the place of balneotherapy in gastrointestinal diseases Internal application: This decreases gastric secretion and motility, detoxification effect and stimulates maturation of germ cells 7) Which final factors are appropriate to use to treat inflammatory processes in gynaecology and sterility. Gynecology: A) acute stage: PRM for anti-inflammatory, fibrinolytic, pain relief effect in acute stage is with antibiotics and UV erythemas. b) In subacute stage – UV erythemas, low frequency pulsed magnetic field, microwaves, ultra-high frequent currencies, ultrasound, electrophoresis with calcium. C) chronic stage: paraffin applications, balneotherapy, interferential currencies, ultra-high frequencies, microwaves, low frequency pulsed magnetic field, UV erythemas. Sterility: PRM is applied after determination of the causes, usually for Fallopian tube damage or blockage, caused by inflammatory processes: ultra phonophoresis with fibrinolytic unguents, electrophoresis with potassium iodite, interferential currencies, low frequent pulsed magnetic field, heat applications, hip baths, balneotherapy. Pages 13-16 Topic: 10 Physioprophylaxis, physical therapy & rehabilitation of some diseases in childhood: Respiratory infections, bronchitis, bronchopneumonia, bronchial asthma. Rheumocardiological- Rheumatism, Cardiopathies, Juvenile Polyarthritis, Exchange-diabetes 1. What are the tasks of primary & secondary physioprophylaxis (for acute respiratory infections)? 2. What is the essence of bronchopneumonia? - Bronchopneumonia is a subtype of pneumonia which is characterized by patchy consolidation involving one or more lobes; typically starts from the terminal bronchioles. 3. What are the more significant pathogenetic changes? - The alveolar macrophages release cytokines such as TNF-alpha & IL-1 in response to infectious agents or dead respiratory cells.These cytokines cause vasodilation & increase the permeability of the blood vessels surrounding the alveoli. This results in fluid shifting from the vascular space into the alveoli => alveolar congestion. 4. What is the behaviour in terms of treatment & rehabilitation? - Antibiotics & antipyretics. - Later stages ( subacute & chronic stage)=> Incorporate some physiotherapy methods such as inhalation therapy with mucolytics & breathing exercises to facilitate the breathing.Later can be done by using the upper & lower limbs to exhale against resistance to train the expiratory muscles. - Percussion drainage - Ultra-high frequency electrical current => around the area of the pneumonia 5. What are the tasks of primary & secondary physioprophylaxis? 6. What is the essence of bronchial asthma? - Asthma refers to reversible narrowing of the airways with production of extra mucus. It can be bacterial or viral but usually there is an allergic component in asthma. 7. What are the more significant pathogenetic changes? - The significant pathogenetic changes include: (i) Increase in mucus production. (ii) Thickening of the basement membrane of the bronchi. (iii) Smooth muscle cell hypertrophy. All of the following changes form a triad for asthma which include: => Airflow obstruction => Bronchial Hyperresponsiveness => Inflammation of the bronchi 8. What is the behaviour in terms of treatment & rehabilitation? - Physiotherapy is not used in the acute stage of asthma but is indicated for the remission stages.Physiotherapy includes: (i) Stimulation of exhalation by breathing exercises. (ii) Use of intranasal iontophoresis with calcium ions to stabilize the cell membranes of the mastocytes & to prevent degranulation => slow down or eliminate the allergic process. (iii) Educate the patient about breathing exercises to facilitate the exhalation & in the remission phase, advise the patient to visit the sea-side or mountain resorts which have very good climate conditions for preventing exacerbation of asthma. Eg: Patients with infectious/ allergic type of Asthma has to be advised to go in a mountain resort called Sandanski & patient with atopic asthma has to be advised to visit the sea-sort resort. 9. What are the tasks of primary & secondary physioprophylaxis? 10. What is the essence of rheumatic heart disease? - Rheumatic heart disease is characterized by damage to heart valves which occurs as a result of severe single episode or multiple recurrent episodes of acute rheumatic fever. 11. What are the more significant pathogenetic changes? - Granulomas (called Aschoff bodies) form underneath the endocardial (innermost) layer of the heart & calcification of the heart valves occur. Most commonly affected valve is the mitral valve => mitral stenosis => can lead to atrial enlargement due to chronic increase in left atrial pressure, predisposing the individual to atrial fibrillation. Aschoff bodies: T hey are granulomatous structures consisting of fibrinoid change, lymphocytic infiltration, occasional plasma cells, and characteristically abnormal macrophages surrounding necrotic centres. 12. What is the behaviour in terms of treatment & rehabilitation? 13. What are the tasks of primary & secondary physio prophylaxis in rheumatic heart disease? 14. What is the essence of metabolic diseases? - Metabolic diseases occur when the body's usual metabolic processes are disrupted. An example of metabolic disease is diabetes mellitus which occurs as a result of impaired carbohydrate metabolism. Diabetes mellitus is an endocrine disease in which the body's ability to produce or respond to insulin hormone is impaired resulting in abnormal metabolism of carbohydrates & increased levels of glucose in the blood. 15. What are the more significant pathogenetic changes? => Type I or insulin dependent: Auto-immune destruction of the pancreatic beta cells which leads to decrease in insulin in the body as beta cells are responsible for the production of insulin. => Type II or insulin independent: Late onset & the body is resistant to insulin. The beta cells keep producing insulin despite the body being resistant to it. On the later stages of type II diabetes, we can include supplementation with insulin to prevent the overuse of the pancreatic cell. 16. What is the behaviour in terms of treatment & rehabilitation? - Insulin injection for type I diabetes & later stages of type II diabetes. The other treatments are specific for diabetic complications: (i) Diabetic foot=>Laser therapy to stimulate granulation; we can also use Darson-valve therapy around the edges of the wound to stimulate the granulation & we can use low frequency pulsed magnetic field to improve the microcirculation. (ii) Diabetic polyneuropathy=> More than one peripheral nerves are affected. It is sensory neuropathy so mostly the sensations are affected at the initial stages. In the later stages, the motor function of the nerves can also be affected.Physiotherapy include: - Low frequency pulsed magnetic field => Improves the microcirculation in the affected areas. Usually the lower limbs. - Low frequency current (Galvanic current) in combination with Nivalin => Process is called ionophoresis. We use positive electrodes because the Nivalin is also positively charged. This helps to improve the neuro-muscular transmission. - To stimulate muscle with disorder in peripheral innervation, we need to use longer pulses (3-6 times longer pulses) because these muscles have lost their ability to accommodate ; we also need exponential shaped pulses with longer duration because their refractory period is longer than those with preserved innervation. - Kinesiotherapy => System of Kabot. A.k.a proprioceptive neuromuscular facilitation technique. By using diff techniques of stretching, or irritating the muscles, we are aiming to provoke stronger muscle contractions. 17. What are the tasks of primary & secondary physioprophylaxis in metabolic diseases? TOPIC 11: Physical therapy & rehabilitation of children’s neurological diseases. Childhood cerebral palsy & obstetric palsy. 1. What are the physiological features of the child’s body? 2. What forms of cerebral palsy do you know? => Based on clinical signs & symptoms, cerebral palsy can be divided as follows: (i) Spastic: Most common type.According to the limbs which are spastic we have following types: - Quadriplegic: All the four limbs are spastic. It is usually associated with mental retardation. - Diplegic: Only the legs are affected. It is not associated with mental retardation. - Hemiplegic: One side of the body is affected. It is not associated with mental retardation. - Monoplegic: Only one limb is affected. It is not associated with mental retardation. (ii) Dyskinetic (iii) Ataxic (iv) Mixed 3. What are the most significant risk factors leading to the development of cerebral palsy? => The most significant risk factors leading to the development of cerebral palsy include: (i) Premature birth (ii) Low birth weight (iii) Multiple pregnancies (iv) Brain hemorrhage (v) Brain asphyxia 4. What specialized kinesiotherapy methods can we use for therapy & rehabilitation of children in cerebral palsy? => Specialized kinesiotherapy methods used for rehabilitation of children in cerebral palsy include: (i) System of Vojta: Reflex physiotherapy. Involves pressing specific points on different sites of the baby to stimulate active movements which are useful for the normal development of the baby. Used up to the 2 year of a child. A fter that this technique switches to the Bobath technique. (ii) Principle of Bobath which is used for: decreasing spasticity; suppressing the pathological movements & re-educating the patients in physiological movements. 5. What is the rehabilitation program for children with birth trauma of the shoulder joint?? (Only have birth trauma of the shoulder/ brachial plexus in our syllables) => The rehabilitation program for children with birth trauma of the brachial plexus include: (i) Electrostimulation using following parameters: - Exponential shape of the pulses with slowly rising fore-front. - Long pulses: 3-6 times longer compared to the duration of pulses because the muscles have a longer refractory period. - Frequency: very low (0.25 Hz upto 0.5 Hz) (ii) Electrophoresis with Nivalin => to improve the neuromuscular transmission. Nivalin is used after the 6th month of development of a child because before the 6th month we do not have forming of the motor plate of the nerve which connects the nerve & the muscle. Before 6th month of age, we use Galvanization by changing the polarity (so changing the cathodes & the anodes). (iii) Low frequency pulsed magnetic field: To decrease edema. It also helps to improve the micro-circulation. (iv) Method of Prof. Gacheva: Uses the normal physiological reflexes of the baby in order to stimulate the active movements in the affected limbs. After the child grows up & is able to do the exercises, he is supposed to => switch to method of Kabat. (iv) Local application of heat therapy such as Solux lamp to stimulate the tropics of the muscle & stimulate recovery of the peripheral nerves. (v) Parafen => Local application of the heat can improve tropics. (vi) Cryotherapy should be avoided when there is problem with peripheral nerves because it slows down the recovery of the peripheral nerves. 6. What are the more significant etiological factors? => Pulling out a big baby aggressively during birth?? 7. What is the behaviour in terms of treatment & rehabilitation? 8. What are the tasks of physioprophylaxis? TOPIC 12: Physical therapy & rehabilitation of vascular disease; discogenous radiculitis & peripheral nerve injuries 1. What are the goals & objectives of physical therapy in patients with stroke in different stages of the disease? => The goals & objectives of physical therapy in patients with stroke in different stages of the disease are as follows: Acute stage: Objectives of physical therapy includes: - Prevention of complications of the musculoskeletal system/ contractures/ muscle & tendon retraction; heterotopic ossification. - Respiratory system => hypostatic pneumonia - Skin => pressure ulcer - Rehabilitation begins in the acute-care hospital in stable patients; often within the first 24 to 48 hrs (on the 2nd day=> ischemic stroke; 4th day => patients with brain hemorrhage). Early recovery period -Patients achieve independence in bed & transfers: standing; walking; activities of daily living. - The patient is trained in sitting & standing. 5th day for ischemic stroke; 10th in the cases of stroke localized in the trunk; 14th day in hemorrhagic stroke & 21st day in subarachnoid hematoma. - Exercise for balance & coordination. - Exercise for the unaffected limbs. - Training in walking & the use of assistive devices such as tetrapod walking stick - Suspension therapy - Exercise for fine movements of the upper limb - Training in activities of daily living; occupational therapy Advanced stage of recovery (6th - 18th month) -To improve independent movements in the affected limbs in order to achieve complex motor patterns. - To improve gait & fine movements. 2. What functional assessment is used to determine the rehabilitation potential? => The functional assessment used to determine the rehabilitation potential in stroke include: (i) Brunnstrom scale (ii) Spasticity (Ashworth scale) (iii) ADL/ Activities of daily living (Barthel index) (iv) Locomotor test: For: a. General condition & changes in consciousness; cognitive deficits. b. Respiratory & cardiovascular system co-morbidities & possible complications. 3. What is the prevention of recurrences & complications? (i) Brunnstrom’s movement therapy (1970): For severe neurological deficit. It emphasizes on synergistic patterns of movement that develop during the recovery from hemiplegia. It encourages the development of flexor & extensor synergies during early recovery; assuming that synergistic activation of the muscle will result in voluntary movement. (ii) Proprioceptive neuromuscular facilitation (PNF) (Myers 1995): For moderate neurological deficit. It emphasizes on using the patient’s stronger movement patterns for strengthening the weaker motions. PNF techniques use manual stimulation & verbal instructions to induce desired movement patterns & enhance motor function. (iii) Bobath(1990): For mild neurological deficit. It aims to reduce spasticity & synergies by using inhibitory postures & movements in order to facilitate normal autonomic responses that are involved in voluntary movements. It leads to: - Reduction of spasticity. - Inhibition of primitive motor synergies. Stimulation of voluntary motor responses by facilitating techniques & positions. - Strengthening of normal autonomic responses that are involved in voluntary movement. (iv) Novel therapy which includes: - Constraint-induced movement therapy (it involves forced use of the involved upper extremity & discourages the use of the unaffected extremity). - Robot- assisted exercise training; & treadmill training with the body weight partially suspended (promotes symmetrical removal of the body weight to facilitate locomotor abilities after stroke) - Mirror therapy: Gives illusion of the affected limb moving normally. 4. What is the etiology of peripheral nerve damage? => Etiology of peripheral nerve damage includes trauma; infections; metabolic disorders such as diabetes; exposure to toxins such as arsenic, lead or mercury; amyloidosis; auto-immune diseases such as rheumatoid arthritis, lupus etc. 5. What is the functional treatment & rehabilitation of peripheral nerve disabilities? Treatment & rehabilitation for Peripheral nerve damage (flaccid paralysis) - Iontophoresis with Nivalin to improve neuromuscular conduction. - Electrostimulation of the muscles - Thermal appliances - Kinesiotherapy => Depends on the result of manual muscle testing (MMT) such as position therapy (for the prevention of contractures); trophic massage;analytical exercises to improve strength & trophics of the muscles. To stimulate the recovery of the nerve lesion - UV, ultrasound in low dosage (partial lesion). - Short- wave diathermy => not earlier than 1 week after trauma. - To overcome the motor deficit & maintain the tropics => electrostimulation.Low-frequency currents with parameters depending on the results of electrodiagnostics: pulses with slowly rising forefront; 200-600 ms duration; pause 2-3-6 times longer than the pulse; very low frequency (0.25-0.5 Hz). - To maintain trophics in the affected muscles => thermal applications; paraffin; mud applications; thermogels. Kinesiotherapy (Depending on the result of manual muscle testing/MMT) - In the beginning => passive exercises to maintain the range of motion in the joints. - Facilitating techniques for the induction & training- which includes method of Kabbath (Proprioceptive Neuromuscular Facilitation/ PNMF). - Exercises from a position of eliminated gravity. - Anti-gravity exercises - Resistive exercises to increase muscle strength. - Trophic massage. 6. What are the criteria & principles in preparing the rehabilitation program? Criteria: Accurate diagnosis by EMG (Electromyography). Objectives: - Prevention of contractures. - Maintenance & restoration of the tone & strength of affected muscles. - Stimulation of re-innervation. 7. What are the features of physical therapy in neuropathia n. Facialis? => Physical therapy in neuropathia n. Facialis include: Physical agents - Solux: 5th- 14th day => Use of blue filter & after the 14th day => use of red filter. - Electrostimulation => after the 30th day, after the individual assessment. - Paraffin applications in cases with contractures. - Massages such as neck massage & mimic exercise. 8. What is the prevention for complications? 9. What is the behaviour & complex treatment of discogenic radiculitis? For lower back pain: => In the acute phase - Rest, positional treatment in a position that provides kyphosis in the lumbar spine. - The legs are flexed in knees & hips; the seat is in suspension by a stool placed at the bottom of the bed. - For analgesia => UV; Iontophoresis with lidocaine; TENS; Laser therapy. - Extensions => Perl; underwater extension method of Gechev; Pavel Banya. - Kinesiotherapy => Post-isometric relaxation (PIR) & methods for automobilization. - Light massage of the lumbar area & deeper in the paretic muscles. - Contraindicated=> Thermal therapy (heat increases venous stasis in the lumbar region & may lead to exacerbation). => Subacute & chronic phase - Ultrasound therapy => To relax the muscles & thixotropic effect on the disc. - Short-wave diathermy - Laser therapy - Kinesiotherapy => Gradual mobilization in lumbar region; exercise to strengthen the abdominal muscles; extensor muscles of the hip & to create muscle waistband. TOPIC 13: Physical therapy & rehabilitation on the surgical diseases, prevention & treatment of post-operative complications, physical therapy & rehabilitation on post-traumatic & obligatory processes of the central nervous system, thermal injuries, ENT & eye diseases 1. What is the general behaviour in patients with traumatic brain injury & volume occupying processes in the early post-operative period? - Rest - Kinesiotherapy (Passive in the acute period, then active), (to improve walking stability) - UV light therapy - Electrophoresis - Thermal therapy - Electrical stimulations of antagonist muscle - LFPMF (Low-frequency pulsed magnetic field) - Balneotherapy (to help with the degenerative process) 2. What is the role of physical factors for functional recovery & readaptation of the sick? 3. What is the behaviour of patients with spinal cord injury in different periods on the run? -First stage (6-10 weeks after trauma) –therapy aims to normalise the spinal shock and reduce the complications - Electrophoresis with Nivalin, Lidocaine, UHF currents, Electrical stimulations, UV light therapy. Kinesiotherapy(passive, breathing exercises and active) -Second stage - to regain some of the independence if possible. Kinesiotherapy can be used but with caution(careful not to cause further damage), underwater gymnastics, Heat therapy, Electrical stimulations (to the affected muscles) -Third stage - Kinesiotherapy - active with wider range. Daily life activities. If needed electrotherapy(to help with muscle spasm) -Fourth stage - Individual walking, Daily life activities, Professional therapy etc. When a patient achieves a certain goal we go to the next step of treatment. 4. What are the tasks of physical therapy with a complex approach? Pages - 23-25 7.Joint play is: Motion of joint on anatomical axis Transitional movement between joint surface Rotatory motion of joints Fill in the necessary data: 1)5 rules for conduction of massage Indications of massage Muscle spasm, sprain, and postural strain of the back Arthralgias and various arthritis Fibromyalgia Lymphedema Anxiety, stress and sleep disorders Sports-related injuries 2)List the names of gymnastic exercises according to the type of m contracture 1. breathing exercises - improve the strength and coordination of respiratory muscles; improve ventilation; maintain the mobility of the thorax; increase effectiveness of cough; prevent pulmonary complications in bedridden patients 2. corrective gymnastics - in scoliosis 3. analytical – improve the strength or ROM according to the disorder 4. general strengthening - used for overall body conditioning 3)Most good excitatory effect on m trophicsis achieved through these kinesiotherapy resources: Trophic massage 4)What kinesiotherapeutic means and methods can be used to achieve muscle relaxation? PIR = postisometric relaxation (active + passive) 5)The DEJ testing aims to? 6)Give an example of combination of kinesiotherapy with other physical factors: Hydrokinesiotherapy:use of common water and kinesiotherapy for example in musculoskeletal disorders 7)Main principles of training: Active training enhances neuroplasticity and results in reorganization of cortical maps by reorganization of existing networks or recruitment of new cortical are or networks 8)Contraindications of active physiotherapy: Contraindications → fractures of the spine severe osteoporosis spinal instability spinal tumors Underline the true answer 1)Infrared rays cause: Photochemical processes in tissues UV light Exogenous heat in tissues Endogenous heat in tissues = HFC 2)The strongest influence on the skin pigmentation is exerted by UVL from: a) the long-wave spectrum; b) the mid-wave spectrum; c) the shortwave spectrum. 3. Ultraviolet rays have their effect on: a) the dermis; b) the hypodermis; c) the epidermis 4. The heat capacity of paraffin is: a) greater than that of water; melting point = 52-53℃ (risk oof burn) (b) less than that of water% 3 (c) identical to that of water. 5. The most valuable properties have: a) estuarine mud; 6) peat mud; c) the mineral mud. 6. Psamotherapy is: a) treatment with para3B b) treatment with sand; c) treatment with seaweed. 7. The emission of the helium-neon laser is in the spectrum of: a) UVL; b) the red visible light; Q. CONFIRM THE REQUIRED DATA: 1. Describe the Gorbachev-Dalfeld method of biodosimetry Definition: Time needed for lightest erythema with sharp borders. - It is measured in time & determines an individual’s skin sensitity to UV light. - Testing is done in 50cm distance from the Quartz lamp. It is applied in certain parts of the body using specific metal plates with 6 windows. Among the metal plates, we have 1 transparent metal plate. The first window is opened for 30 sec. After 30 sec, the second window is opened & so on Biodose is usually around 3rd/ 4th window. - At the end of exposure, the time of exposure for 1st window is 3 mins & for last window is 30 sec. 2. List 5 criteria influencing the individual sensitivity of the skin UVL. Biodose Individual sensitivity depends on age, sex & endocrine function Most sensitive - Abdominal area & lumbar area (Most sensitive) - Chest back (2nd) - Folding parts (3rd ) - Extending parts (4th) Least sensitive - Hands & Feet 3. Types of schemes for subertemic radiation. 4. Features of laser radiation. Coherent, monochromatic,polarized, collimation 5. List the protective equipment for staff and patients at work with light sources, goggles and face- shields 6. List the application methods in cryotherapy. Cryogel; Frozen ice gel & ice-cubes can be used 7. List 3 main factors in peloidotherapy. = Mud therapy -Liman mud - Mineral spring mud - Peat mud 8. List the indications for "sauna" therapy Degenerative joint disease Obesity Diabetes Physio BG sample test (28 pages) 1) Write a definition for “Rehabilitation”: 3 point - Use of all means aimed at reducing the impact of disabling and handicapping conditions and at enabling people with disabilities to achieve optimal social integration. - A process aimed at the preventative of preventable disability during the period of treatment of diseases and helping the disabled person to achieve the maximum physical, mental, professional, social and economic fullness to which he is fit within the existing disability. 2) Name three reformed physical factors? - Ultrasound/Laser radiation/Pulsed magnetic field/Ionizing radiation/Microwaves. 3) Which of the following effects is characteristic of low frequency currents? 1 point - Immunostimulant - Analgesic - Stimulating callus formation 4) Name three types of electrotherapy procedures that require the use of hydrophilic pads: Electrophoresis Galvanic therapy (low frequency current) Diadynamic Therapy Medium frequency current 5) Thermal effect has the following reshaped physical factors: a) Interfering currents b) UHF electric magnetic field c) Microwaves d) Galvanic current 6) Which physiological parameter correlates the pulse duration: a) Chronaxie b) Rheobase (intensity) c) Refractory period (duration of pause) 7) 3a high frequency currents is characterized by the following effects a) Anti-inflammatory b) Excitatory c) Formation of exogenous heat = Instead endogenous heat 8) The generators for ultrasound therapy are built on the principle of: a) Oscillating circle b) Reverse piezoelectric effect c) Magnetron 9) Write the range of the infrared spectrum of light. - 760-10000nm 10) Name three healing effects of soft laser radiation: a. Heat-photochemical thermal = high intensity ???? a) Regeneration biostimulation ⇒ accelerated healing b) Improves blood circulation c) Stimulates nominal reactivity d) Dispersing action e) Analgesic effect 11) Write three methods for cryotherapy - Baths - Electrocryotherpy - Cryolaser therapy - Icepacks - Cold sprays - Snow - Frozen towel - Cold bandages - Ice cubes - Crushed ice - Chloroethyl injection 12) Name three forms of active kinesitherapy: a) Gymnastic exercise b) Exercises with applied character -walking, running, swimming c) Underwater gymnastics d) Suspension and pulitherpy, training in walking with aids, field treatment, games and elements of sports, occupational therapy (elf-service,leisure, functional, professional) 13) Indicate three diseases of ODA for which the application of suspension therapy is appropriate Osteoarthritis Low back pain Stroke Peripheral nerve damage sprains Muscle degeneration Algodystrphic syndrome after acute phase BG sample test Pages 4-14 14. In peripheral nerve damage, the assessment of muscle weakness is performed by: a / Brunstrom testing (evaluation of motor deficiencies: stroke rehabilitation) b / locomotor test (evaluation of motor deficiencies: stroke rehabilitation) c / Manual muscle testing 1 point. 15. From what age can physical factors be applied to children: a / from 1 month of age b / from 1 year of age c / after Zg. Age 1t. ? 16. List three neurological diseases for which the application of specialized kinesitherapy methods is appropriate: birth trauma of the brachial plexus (System of Prof. Gacheva) stroke (system of Bobath) cerebral palsy (system of Vojta) hemiplegia 17. Name three physical factors to improve muscle trophism: 1. diadynometry (use Rhythm syncope) 2. pulsed magnetic field 3. UZ??? 4. Low frequency impulse current (LFIC): use rectangular /triangular waveforms 18. Name three diseases in which electrical stimulation is applied: 1. ODA - degenerative joint diseases, hydrops, sprains, muscle atrophy, myositis, myalgias 2. NS - paresis and paralysis, neuritis, neuropathy 3. Pain Scoliosis Spondylosis Birth trauma of brachial plexus 19. The balneotherapy is an obligatory stage of the treatment of: a / peptic ulcer of the duodenum b / bronchial asthma c / nephrolithiasis d / reactive arthritis (rheumatoid arthritis) 20. Determine the rehabilitation complex in children with birth trauma of the shoulder plexus at the age of 5 months: a / kinesitherapy according to Voita and Bobat (kinesiotherapy according to prof. Gacheva ten replaced with Kabath) b / passive kinesitherapy massage c / phonophoresis. 1. Write a definition for "Rehabilitation potential" Ans: The patient’s potential to achieve goals set by the PRM specialist. This can be categorised as: fair, guarded or poor Fair indicates the patient is able to follow the plan of care and progress towards goals. Guarded indicates doubt about the patient’s potential Poor indicates that the patient is unable to achieve the goals This is based on cognitive function, medical status of the patients, motivation, social support and economic resources. 2. Which of the following effects is characteristic of midrange currents? a / creation of endogenous heat = in HFC b / analgesic c / thermal effect in depth = in HFC 3. Dosing in procedures with low frequency currents shall be performed: a / with biodosimeter =in UV light b / according to the patient's feeling c / by examination of chronaxia 4. Electrostimulations of the neuromuscular apparatus are appointed at: a / vegetative dystonias (use as an analgesic effect)- hypotrophic & peripheral nerve damage b / spastic paralysis c / bronchial asthma 5. Interference currents are not characterized by the following effect: a / thermal effect in depth b / stimulating callus formation effect c / analgesic effect 6. The group of high-frequency currents does not include: a / d'arsonval currents b / microwaves c / sinusoidal-modulated currents (medium frequency current) 7. Ultrasonic waves are: a) monochromatic coherent radiation (laser radiation) b / mechanical oscillations of the particles of the elastic medium c / electromagnetic radiation with a frequency of 16-20 000Hz (ultrasonic is >20kHz) 8. Write the wavelength of light from the UV spectrum: UV spectrum range: 100 - 400nm Group A = 315-380nm Group B = 315-280nm Group C = 180 -280nm 9. Visible rays have the following effects: a / thermal b / photoelectric c / photochemical 10. Name three characteristic features of laser radiation 1. Coherent - The individual light waves are in phase with one another. 2. monochromatic - Specificity of light in a single, defined wavelength 3. Polarized 4. Collimated unidirectionality - minimal divergence of the radiant flux 11. The characteristic features of erythema obtained by exposure to infrared rays are: has a vasomotor character appears shortly after exposure disappears shortly after irradiation there is a spotted x-ray without clear boundaries redness may occur in distant areas 12. List three diseases suitable for paraffin treatment: Stroke Cerebral palsy Traumatic brain injuries Raynauds disease Bell’s palsy Periarthritis in chronic stage Tendovaginitis in subactute and chronic stage Sinusitis in chronic stage Bartholinitis in chronic stage Peripheral nerve damage 13. Name three forms of passive kinesitherapy: Massage Traction therapy Mechano-therapy Manual therapy 14. Suspension therapy is a method in which physical exercises are performed: a / against gravity b / with eliminated gravity c / against resistance 15. Manual muscle testing is a method of assessing: (2 points) a / functional assessment of SSS b / assessment of muscle weakness c / assessment of the volume of movement in the joints d / assessment of muscle strength 16. Brunstom testing is a methodology for a / assessment of spasticity (Ashworth scale) b / assessment of muscle weakness (Manual muscle testing) c / the independence of the patient 17. Improving muscle trophism can be achieved by: - Electrostimulation - Kinesiotherapy - Neuromuscular neurostimulation - Functional electric stimulation - Electric muscle stimulation a / kinesitherapy b / chemotherapy c / balneotherapy 18. In acute algodystrophic syndrome, the following procedures are appropriate: (5t) (SUDECK DYSTROPHY or Complex regional pain syndrome) Acute, Dystrophic & Atrophic Stages (segmental and reflective use of therapy in areas of relevant sympathetic ganglia e.g. upper limb - cervical ganglia, Lower Limb - lumbar ganglia) - Cryotherapy (local application) - low frequency pulsed magnetic field (local application) - active kinesiotherapy (preserve motion) - Ultrasound - UV therapy (high dose to block sympathetic activity) - Biphasic diadynamic currents (local) - Interferential Currents (local) Atrophic Stage - (everything mentioned above) - Electrostimulation 19. In the case of a fracture with metal osteosynthesis, the following preformed physical factors may be applied: (Zt) a / Low frequency pulsed magnetic field (for reduction of oedema & stimulation of micro-circulation & metabolism). b / Ultrasound c / microwaves 20. Suggest an exemplary rehabilitation complex for post-stroke hemiparesis in resp (5t) Use Brunstrom scale to evaluate recovery Grade Description 0 - No increase in muscle tone 1 - Slight increase in tone giving a catch when the limb is moved in flexion or extension. 2 - More marked increase in tone but limb easily flexed. 3 - Considerable increase in tone -passive movement is difficult. 4 - Limb rigid in flexion or extension - Physiotherapy starts on the 2nd day after ischemic stroke and 3rd/4th day after hemorrhagic stroke Training to get the patient in sitting and standing - 5th day after the accident of ischemic stroke - 10th day after the accident of cerebral trunk - 14th for after the accident of brain hemorrhage - 21st for after the accident of subarachnoid hemorrhage Use System of Bobath and Kabath - aim to reduce/prevent spasticity - Heat Therapy - Cryotherapy - Electrostimulation of antagonist muscles - Lye/paraffin tanning stage: a / sitting in legato LFK b / walking around legato c / hodene 100 meters r / self-service 21. Write the basic principles of medical rehabilitation early initiation, phasing, continuity, individuality, comprehensiveness, patient cooperation 1.Optimize function 2.Relieve pain 3.Prevent and manage complications 4.Coordinate care 5. Educate and empower patients Avoid aggravation: It is important not to aggravate the injury during the rehabilitation process. Timing: The therapeutic exercise portion of the rehabilitation program should begin ASAP. Compliance: without compliance, the rehabilitation program will not be successful. Individualization: each person responds differently to an injury and to subsequent rehabilitation program. Specific sequencing: therapeutic exercise should follow a specific sequence of events. Intensity: intensity levels of the therapeutic exercise must challenge the patient and the injured area but at the same time must not cause aggravation. Total patient 22. The group of low-frequency currents includes: a / diadynamic currents b / sinusoidally modulated currents (medium frequency) c / darsonval currents (high frequency) d / microwaves (high frequency) 23. The specific effects of galvanization are most pronounced in: a / polar zones (electro-neutralization of big molecules) b / peripolar zones c / interpolar zones (non-specific effect) 24. Classical electrodiagnostics is made at: a / elastic paralysis b / damage to a peripheral motor neuron c / inactive hypotension 25. With which physiological parameter does the intensity of the pulses for electrical stimulations correlate: a / chronaxie b / rheobase c/ accommodation capacity 26. The group of high-frequency currents includes (2) a / darsonval currents b / microwaves (decimeter and centimeter waves) c / sinusoidal-modulated currents (medium frequency current) 27. The magnetic field generated by the device Magnet H80 is: a / variable low frequency 50 Hz b / constantly modulated with progressive frequency c / variable high frequency 433 Hz 28. Infrared rays have the following effects: a / thermal b / photoelectric c / photochemical 29. Determination of individual photosensitivity is mandatory when exposed to UV C …… rays and measured in peobazi [the intensity of UV radiation is measured in the units of milliwatts per square centimeter (mW/cm2). A pyranometer is a type of actinometer used for measuring solar irradiance on a planar surface and it is designed to measure the solar radiation flux density (W/m²)] 10. List three indications for "sauna therapy" Degenerative joint disease Obesity Diabetes Mild hypertension Migraine Neurosis Sinusitis and bronchitis Dermatitis 11. Name three main factors of impact of the healing mud: (for musculoskeletal disorders and skin diseases) thermal / chemical / mechanical / physicochemical [The physiological mechanisms are thermal, chemical (hormone-like substances, huminic acid and sulfur) and mechanical] Physio BG sample test (28 pages) Pages 26-28 12.Indicate three main methods of balneotherapy: a. Sulfur baths a. Mineral baths b. Radon- carbon dioxide baths Google: Balneotherapy is a method of treating diseases by bathing 13. Name three types of medical gymnastics a. Breathing exercise a. general strengthening b. analytical exercise 14. Callus formation can be stimulated by the following physical factors: a. ultrasound b. electrophoresis c. interference + laser 15. In cystic fibrosis, the following physical procedures are appropriate: a. breathing gymnastics b. massage 16. Name three reformed physical factors for influencing spasticity in CNS diseases: - Heat therapy - Hydrotherapy - Electrostimulation of the antagonist muscle 17. Indicate in which diseases electrical stimulations are not applied: a. bronchial asthma b. Bell's palsy in acute stage c. inactive hypotrophy d. elastic paralysis 18. Climatotherapy is a mandatory stage of treatment of: a. duodenal ulcer b. bronchial asthma c. Nephrolithiasis d. reactive arthritis 19. Name three contraindications for rehabilitation in acute myocardial infarction: a. cardiogenic shock b. RPN c. Osn 20.Determine the rehabilitation complex in case of post-traumatic joint contracture: a. Cryotherapy b. electrostimulation and phoresis with muscle relaxant (ncht) c. kinesitherapy.. + thermotherapy and paraffin Doc name - Physio BG practice open questions Pages 1-4 1. Physioprophylaxis (AF), physical therapy and rehabilitation (FTP) of ischer heart disease, incl. myocardial infarction. FIP and FTR of hypertension. -MI:- Phases of PRM therapy I - hospitalization II-early recovery III - the late recovery Stage of hospitalization Stage 1 - active movement in small joints, breathing. exercises, turning in bed, semi-sitting position Stage 2 - seated in bed Stage 3 - exercises from a sitting position, self service Stage 4- breathing exercises with diaphragmatic breathing, walking with slow rate around the bed Stage 5- exercises from standing position, walking equally to 100 m Stage 6 – exercises for the trunk from seat position and for lipbs from standing, walking on stairs Stage 7 - 500 meters per day, 2 floors Pulse - 20 beats / min RR - 20 mm Early recovery stage Physical exercises under the real capacity; Kinesiotherapy, velotests / time interval stresses - 15 min / tredmil, field treatment - 30-40 minutesPulse - 120 beats / min.RR - 50 mm Later recovery stage Velotest - 2 m. Kinesiotherapy - gymnastic exercesises Breathing exerceses Field treatment Maintenance phase Kinesiotherapy - 45-60 min - aerobic type exercesises Bicycle workout with 60-80% of max. capacity Field treatment to 5 km Hiking Swimming and elements of sports Kinesitherapeutical workout a period of 6 months- increases aerobic capacity and limiting border of myocardial ischaemia. 2. FTR of some vasopathies (M. BURGERI, M. RAYNAUD). -PRM icludes: local thermal procedures - lye & paraffin applications, LFPMF for improving the microcirculation, D'Arsonvalization for strengthening the blood vessels wall layer, US - segmentary to supress the sypathetic gangia, massage, active kinesitherapy exercises for stimulation the normal blood circulation. 3. FTR in varicose veins and varicose symptom complex. Physio Prophylaxis of thromboembolic complications. Varicose veins & varicose symptom complex - D’arsonval - Magnetic therapy - 4.FTR of their nonspecific lung diseases (bronchitis), FTR of bronchial asthma. Bronchitis - Solux or infra-rouge lamp in the area of lungs on the backside usually (between the scapulas) - UV light in sub-erythemal doses: stimulate activity of the immune system - Inhalation therapy (used in general pulmonary disorders) with mucolytics ⇒ liquify secretion ⇒ facilitate the expectoration - Kinesiotherapy with breathing exercises (percussion, vibration & massages of the back & the thorax) - Ultra-high frequency electric current: for anti-inflammatory effect. - Low frequency pulsed magnetic field=> To improve the micro-circulation & to reduce the edema in the bronchial tree Bronchial asthma - Physiotherapy is not used in the acute stage of asthma but usually in the REMISSION stages. - The exhalation is mostly affected so you have to stimulate the exhalation by breathing exercises. We can use intra-nasal iontophoresis with calcium ions which can stabilize the cell - membranes of the mastocytes & to prevent degranulation so it can slow down or eliminate - the allergic process. - Educate the patient about breathing exercises to facilitate the exhaling & in the remission phase, advice patient to visit the sea-side or mountain resorts which have very good climate condition for preventing exacerbation of asthma. Eg: Patients with infectious/ allergic type of Asthma has to be advised to go in a mountain resort called Sandanski & patient with atopic asthma has to be advised to visit the sea-sort resort. 5.. FTR of diseases of the digestive system (gastroduodenitis, gallstones disease). Gallstone - Acute stage: Heat therapy such as Solux & infra-rouge for pain relieving & spasmolytic effect. : Ultrahigh frequency electrical current => Anti-inflammatory effect. : Kinesiotherapy => General strengthening exercises w/o jumping & running to prevent migration of gall stones towards the bile ducts & to cause occlusion. : Balneotherapy=> Treatment with mineral water. For eg: drinking of alkaline water with sulphates (t.d.s) have hologolic & holoretic effect. It stimulates the production & elimination of bile from the gall bladder => ↓ sizes of the gall stone & prevents further production of stones in the gall bladder. Gastroduodenitis - 6. FP and FTR of patients with renal and urological diseases. Nephrolithiasis Performed in non-complicated cases and includes: - Heat therapy (Solux or infra-rouge for their spasmolytic & pain-relieving effect). - Ultra-high frequency electrical current - Balneotherapy: Mineral water ~1500-2000 ml/day divided 3-6 xa day, around 40 mins before meal. - Water strike technique: Used if the kidney stones < 4mm in diameter. Not usually as often these days. Drinks ~1500 ml of mineral water with temp around 38℃ in a short-period of time (5-10 mins) the patient is premedicated with spasmolytic drugs. After this is done, ultrasound or sinusoidally modulated current (2nd type) is applied around the ureter to st

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