SAT 3/20 Excerpt from: Requirements and Procedures for Firefighter Candidates Tracy Wilson It can be extended at the discretion of the Personnel Department. Which of these BEST defines the word discretion as it is used in this sentence? A) efforts B) judgment C) advancement D) highest percentage

Answer 3/20 B is correct The correct answer is judgment. The definition of the word discretion is judgment. In context, this option is the only one which can replace the word discretion.

What are the phases of healing and why are they important to therapeutic exercise?

Inflammatory Response Phase- Begins immediately following injury Lasts approximately 2 to 4 days Fibroblastic Repair Phase-Lasts approximately 4 to 6 weeks after injury Regeneration and repair of the injured tissue Maturation-Remodeling Phase- Long-term process May require several years to complete Realignment and remodeling of scar tissue according to the stresses placed up on it

Therapeutic Exercise

Overview Therapeutic exercise- Goal: return the injured athlete to activity in a safe and timely manner

Components-1 Immediate first aid and management Begins immediately after injury Very critical; impacts course of rehabilitative process Controlling swelling R-rest I-ice C-compression E-elevation

Components-2 Reducing or minimizing pain RICE Therapeutic modalities

Components-3 Restoring range of motion Injury always followed by some degree of ↓ROM Limiting loss and ↑ROM back to normal or better is important for any rehab program PROM AROM

Components-4 Restoring muscular strength, endurance, and power Essential to restoring function of body to pre-injury status Strength-ability of muscle to generate force against some resistance Endurance-ability to perform repetitive muscular contractions against some resistance for an extended time Power-ability to generate force rapidly

Components-4 Isometric contractions-contraction while muscle length remains constant Isotonic-contraction while the length of the muscle changes Concentric contractions-contraction while muscle is shortening Eccentric contractions-contraction while muscle is lengthening Isokinetic contractions-muscle contraction that occurs at a constant velocity

Components 4- Closed chain-exercises that are performed when feet or hands are weight bearing Open chain-exercises that are performed when one foot or hand is not in contact with the ground or some other surfaced

Components 4- Overload principle-for a muscle to improve in strength, it must be forced to work at a higher level than it is accustomed to Exercises are progressively increased depending on the healing process

Components-4 Progressive Resistive Exercises-strengthen muscles through ROM with some fixed resistance Use isotonic contractions Circuit Training-exercise stations that consist of various combinations of activities Plyometric Exercise-involves a rapid eccentric stretch of a muscle followed immediately by a rapid concentric contraction

Components-5 Reestablishing neuromuscular control Production of coordinated movements Strength exercises (especially functional one) help body “relearn” movements need to perform tasks of sport

Components-6 Regaining balance Essential athletic skill Lack of balance may predispose one to further injury or reinjury

Components-7 Maintaining cardiorespiratory fitness Levels of cardiorespiratory fitness may decrease rapidly when athlete is injured Alternative activities may be implemented until at the appropriate point in healing process for others

Components-8 Functional progressions Series of gradually progressive activities designed to prepare athlete for return to a specific sport Sport specific activities

The steps of therapeutic exercise are on a continuum much like the healing process. Progression from one component to the next should be guided by the healing process and the patient’s body and injury.

Critical Thinking A soccer player has been diagnosed as having a grade 2 MCL sprain. The team MD reffered her to PT who is in charge of her rehab program. What are the STG og a rehab program, and how can these be achieved?

Discuss project Pick injury for rehab project.

SAT 3/21 The new country lay open before me: there were no fences in those days. Sometimes I will follow the sunflower-bordered roads. What grammatical error occurs in this sentence? A) wrong noun form B) wrong verb tense C) subject-verb disagreement D) pronoun-antecedent disagreement

Answer 3/21 B is correct The sentence's grammatical error is wrong verb tense. The surrounding sentences use past tense verbs ("lay" and "were"), but the last sentence in the excerpt suddenly changes into a future tense verb ("will follow") which makes little sense with the adverb "Sometimes" (implying something that happpened in the past) and with the other past tense verbs used in the previous sentence. The verb tense that should have been used in the sentence was "followed."

What are some STG?

What are some LTG

Injury Treatment

Injury Treatment 2 areas Therapeutic Modalities Therapeutic Exercise

Therapeutic Modalities Non-exercise treatment options Include the use of: Heat Cold Electrotherapy Massage Traction Ultrasound Compression Vocabulary Indications-reasons/injuries where it is appropriate to use the modality Contraindications-reasons/injuries where it is inappropriate to use the modality

What are indications

What are contraindications

Thermal Modalities Transfer energy to or from the tissues; exchange of energy based on a temperature gradient Energy transferred through Conduction-between two objects that are touching Convection-movement of a medium (water, air) Radiation-transfer without the use of a medium Conversion-energy changed to another form Evaporation-liquid to gas state

Thermal Modalities Cryotherapy-application of cold modalities Effects: Vasoconstriction Decreased rate of cell metabolism Decreased production of cell waste Reduction of inflammation Decreased nerve conduction Decreased pain Decreased muscle spam Decreased muscular force production

Thermal Modalities Cryotherapy Types: Ice bag Ice cup Cold whirlpool Indications: Acute injury or inflammation Acute or chronic pain Small, superficial, first-degree burns Postsurgical pain and edema Use in conjunction with rehabilitation exercises Acute or chronic muscle spasms neuralgia Contraindications: Cardiac or respiratory involvement Uncovered open wounds Circulatory insufficiency Cold allergy/cold-induced urticaria Anesthetic skin Advanced diabetes Peripheral vascular disease Raynaud’s phenomenon Lupus Cryotherapy Types: Ice bag Ice cup Cold whirlpool Ice immersion

Thermal Modalities Thermotherapy- application of superficial or deep heating agents Effects- Vasodilation Increased rate of cell metabolism Increased delivery of leukocytes Increased capillary permeability Increased venous and lymphatic drainage Edema formation Removal of metabolic wastes Increased elasticity of collagen-rich tissues Analgesia and sedation of nerves Decreased muscle tone Decreased muscle spasm Decreased pain Increased nerve conduction and velocity

Thermal Modalities Thermotherapy Indications: Types: Subacute or chronic inflammatory conditions Reduction of subacute or chronic pain Subacute or chronic muscle spasm Decreased range of motion Hematoma resolution Reduction of joint contractures Contraindications: Acute injuries Impaired circulation Advanced arthritis (vigorous heating) Poor thermal regulation Anesthetic areas Neoplasms thrombophlebitis Thermotherapy Types: Superficial Heat pack Warm whirlpool Warm immersion Infrared lamps Paraffin baths Deep Heat Microwave diathermy Shortwave diathermy ultrasound

Deep Heating Agents Therapeutic Ultrasound-deep-penetrating modality capable of producing changes in tissue through both thermal and nonthermal mechanisms Uses acoustical energy Effects Deep-heating Increase rate of tissue repair Wound healing Increased blood flow Increased tissue extensibility Breakdown calcium deposits Reduction of pain Reduction of muscle spasm Deliver medications

Deep Heating Agents Ultrasound Continuous Output Pulsed Output Used for heating tissues Pulsed Output Nonthermal effects The closer the duty cycle is to 100% the more thermal effects there are. The lower the duty cycle, the less thermal effects

Deep Heating Agents Nonthermal Effects Thermal Effects Increased cell membrane permeability Altered rates of diffusion across the cell membrane Increased vascular permeability Secretion of cytokines Increased blood flow Increased fibroblastic activity Stimulation of phagocytosis Production of healthy granulation tissue Synthesis of protein Synthesis of collagen Reduction of edema Diffusion of ions Tissue regeneration Formation of stronger, more deformable connective tissue Thermal Effects Increased sensory nerve conduction velocity Increased motor nerve conduction velocity Increased extensibility of collagen-rich structures Increased collagen deposition Increased blood flow Reduction of muscle spasm Increased macrophage activity Enhanced adhesion of leukocytes to damaged endothelial cells

Deep Heating Agents Indications Contraindications Joint contractures Acute conditions (continuous) Ischemic areas Areas of impaired circulation/artery disease Over areas of deep vein thrombosis Anesthetic areas Over cancerous tumors Over sites of active infection of sepsis Over spinal cord or large nerve plexus (high doses) Exposed metal that penetrates skin Areas around eyes, heart, skull, or genitals Over the thorax (pacemaker) Pregnancy when over pelvic or lumbar areas Over fracture site before healing is complete Stress fracture sites or sites of osteoporosis Over the pelvic of lumbar area in menstruating patients Indications Joint contractures Muscle spasms Neuroma Scar tissue Sympathetic nervous system disorders Trigger areas Warts Spasticity Postacute reduction of myositis ossificans Acute inflammatory conditions (pulsed) Chronic inflammatory conditions (pulsed or continuous)

Temperature Increases and Their Desired Effect Deep Heating Agents Temperature Increases and Their Desired Effect Classification of Ultrasound Temperature Increase Used for Thermal Effects Mild 1ºC Mild inflammation, accelerating metabolic rate Moderate 2°-3°C Decreasing muscle spasm, decreasing pain, increasing blood flow, reducing chronic inflammation Vigorous 3°-4°C Tissue elongation, scar tissue reduction, inhibition of sympathetic activity

Rate of Ultrasound Heating (temperature increase per minute) Deep Heating Agents Rate of Ultrasound Heating (temperature increase per minute) Intensity Tissue Depth 1MHz 3MHz 0.5 0.04°C 0.3°C 1.0 0.2°C 0.6°C 1.5 0.9°C 2.0 0.4°C 1.4°C

Deep Heating Agents Shortwave diathermy-uses high frequency electromagnetic energy to produce deep heat within the tissue Effects similar to thermal and nonthermal ultrasound

Deep Heating Agents Effects Thermal- Nonthermal- Increased microvascular perfusion Activation of fibroblast growth factors Increased macrophage activity Nonthermal- Heating of large area of tissue Heat retained 3 times longer than ultrasound

What is thermal and non thermal

Deep Heating Agents Indications Acute trauma (nonthermal) Contraindications Ischemia Hemorrhage Acute inflammation (thermal) Metal within the output field Pacemaker Presence of moisture Moist dressing, adhesive tape, skin creams Skull (extreme caution) Contact lenses must be removed before application over head Pregnancy (over pelvis, abdomen, or lumbar) Menstruating females (over pelvis, abdomen, or lumbar) Unfused epiphyseal plates Indications Acute trauma (nonthermal) Acute inflammation (nonthermal) Edema reduction (nonthermal) Subacute inflammation Pain syndromes Muscle spasms Chronic inflammation Increase blood flow Stretching collagen-rich tissues

Precautions Against Metal Within the Field of Shortwave Diathermy Deep Heating Agents Precautions Against Metal Within the Field of Shortwave Diathermy In the Environment Near or On the Patient In the Patient Beds Treatment tables Chairs Wheelchairs Metal stools CPM Units Splints Braces Medical instruments Electrical modalities Jewelry Body piercings Earrings Watches Metal in pockets (keys, etc.) Belt buckles Zippers Metal underwire bras Hearing aids Orthodontic braces Dental fillings Implanted fixation devices External fixation devices Metal heart valves Artificial joints Metal IUDs Cardiac pacemakers Implanted bone growth generators Phrenic pacers

Electrical Stimulation Electrical stimulation-modality that utilizes electrical currents Electricity-force created by an imbalance in the number of electrons at two points (poles) Electrons flow in an attempt to equalize difference in charges—this creates an electrical current Negative pole-area of high electron concentration Positive pole-area of low electron concentration Closed circuit-formed when a complete path is formed between the 2 poles Electrical Currents Direct Current-uninterrupted, one directional flow of electrons; square wave Alternating Current-direction of flow changes from positive to negative in a cyclical manner; no true positive or negative poles; electrons go back and forth between electrodes Pulsed Current-one direction of flow that is interrupted by periods of no current flow

Electrical Stimulation Vocabulary Electrode leads-wires that conduct the current to and from the generator, electrodes, and patient Electrodes-introduce the current into the body; point where the electrode contacts the skin is where the electrons are converted into ions When placed closer together, current flows superficially When places farther apart, the deeper the current flows

Electrical Stimulation Indications Controlling acute and chronic pain Reducing edema Reducing muscle spasm Reducing joint contractures Inhibiting muscle spasms Minimizing disuse atrophy Facilitation tissue healing Facilitating muscle reeducation Facilitating fracture healing Strengthening muscle Contraindications Cardiac disability Pacemakers Pregnancy (over abdomen, pelvis, and lumbar regions) Menstruation (over abdomen, pelvis, and lumbar regions) Cancerous lesions Sites of infection Exposed metal implants Areas of nerve sensitivity Carotid sinus Esophagus Larynx Pharynx Around or on eyes Upper thorax Temporal region Severe obesity Epilepsy Electronic monitoring equipement

Electrical Stimulation Types High-Voltage Pulsed Stimulation Transcutaneous Electrical Nerve Stimulation (TENS) Interferential Stimulation Neuromuscular Electrical Stimulation Iontoporesis Microcurrent Electrical Stimulation

How are modalities used in the rehab process

MLA citation Prentice, William E. Essentials of athletic injury management. 9th ed. Place of publication not identified: Mcgraw-Hill, 2010. Print. APA Prentice, W. E. (2010). Essentials of athletic injury management (9th ed.). Place of publication not identified: Mcgraw-Hill.

What are the components of rehab.

Control swelling Reduce pain Restoring full ROM Reestablishing core stability Restoring muscle strength, endurance power Reestablishing neuromuscular control Regaining balance Maintaining cardio respiratory fitness Incorporating functional progressions