deals with prevention/Dgx/Tx of patients with limited functionality / DISABILITY

⇒ assists individuals to achieve + maintain:

• optional functionality,
• socio-professional + home re-integration
• cognitive/psychological ability + quality of life

1. Pain (chronic/acute)
2. Rheumatic diseases
3. Neuro diseases
4. musculoskeletal + neuromuscular
1. post-traumatic
2. gait + walking disorders
5. Skin
1. decubitus + other skin wounds
2. incl. amputations/burns
6. CV + respiratory diseases
7. neoplasia
8. geratric + pediatric rehab

1. (early) medical stage = onset + Tx of disease
2. Socio-professional rehab stage = i.e. self-care + occupational rehab

1. Self-care
2. work + educational acitivity
3. age-appropriate (leisure) acitivities (i.e. sports, social acitivies)

1. Adjuvant Tx methods (→ prepare for proper occup. acitivity)
1. Physical agents are esp. useful during this stage!
2. Methods + Equipment that needed to be performed/used used later in the process
3. Execution of the everyday-life activites by the patients
4. Occupational performance archieved

1. mobility
2. self-care
3. communications
4. object manipulation (i.e. keys, doors, windows)

1. household-activites
1. object manipulation (vacuum cleaner, fridge etc)
2. community skills (i.e. shopping, public transportation, financial planing)
3. Self health care (medicine, setting up doctor appointment)
4. Safety measures

F → it is just part of it

medical speciality that uses natural PHYSICAL factors:

⇒ mineral water

⇒ mud

⇒ climate factors

all artificial + occupational

• active + passive movement
• isometric, isotonic + stretching 📷
• water -exercises

1. JOINT
1. ↑motion + functionality
2. ↓swelling
3. ↑bone density
2. MUSCLES
1. ↑strength
2. ↑static endurance
3. ↑Aerobic capacity

• Post-exercise pain lasting more than 2 hours
• Undue fatigue
• Transient increased weakness
• Increased joint swelling

all of them basically

• Pain amelioration:
• low-frequency current (TENS, diadynamic),
• medium-frequency (interferential),
• high-frequency (diathermy),
• ultrasound
• low LASER therapy.
• Stimulating circulation: Enhancing blood flow to affected areas.
• Decreasing contractures: Reducing muscle stiffness and immobility.

COLLAGENASE → JOINT DESTRUCTION

cold → ac. inflammatory joint

heat → subacute/chronic joint

learn how to deal with ACTIVITIES OF DAILY LIVING (ADL) with their disability

→ self-care

+IADL

1. wrist extension splint 📷
2. paddle splint 📷

• Strenghtening all muscles that cross the affected joint
• ↑ROM + streching
• gait, balance + aerobic
• teach joint protection
‣
What ↓ the stress on the joint?
• good posture + change posture regularly
• maintain ROM + strenght
• reduce joint pain/load
• unload painful joint
• avoid overuse
• use adaptive equipment (i.e. splints)

‣

💬

hand splinitng → esp. 1st CMC

T

1. Cancer redflags?
1. history of cancer
2. night pain, weightloss
3. age >50
2. Trauma history?
3. Neuro/Nerv?
1. Sensory disturbances?
2. Neurological disease?
4. Inflammation? → Fever?
5. Urination problems, i.v. drug abuse? → RF?
6. steroids? → osteoporotic fracture (female: ↑risk)

Mnemonic: CUNITS

1. pain / sensory disorders in specific dermatomes
2. ↑ with coughing + sneezing

4. (Schober)

• VIsual analog (assessment) scale 📷→ good for evolution evaluation
• Questionaires → Oswestry 📷 + Roland Morris
‣
How do you evaluate the questionairs? (scoring)
• 0% to 20% Minimal disability: The patient exhibits minimal disability and can effectively perform most daily living activities. Treatment may not be necessary, except for providing advice on proper lifting and carrying techniques (back school program).
• 21% to 40% Moderate disability: The patient experiences pain and disability when sitting or standing, avoiding activities such as traveling and socializing. Professional activity may also be affected. Personal care, sexual activity, and sleeping remain unaffected. Conservative treatment is recommended.
• 41% to 60% Severe disability: Pain is the primary issue in this patient group, impacting activities of daily living. Detailed investigations are necessary.
• 61% to 80% Marked functional limitations and participation restrictions: Low back pain significantly limits the patient's functionality and participation in various aspects of life.
• 81% to 100% Bed-bound or exaggerating symptoms: The patient is either bed-bound or demonstrating exaggerated symptoms.

ANALGESICS + ANTI-INFLAMMATORY

1. NSAIDS + Analgesics
2. STEROIDS
3. GABA derivates
4. anxiolytics

1. Exercise therapy
‣
early vs. late exercise therapy?
• early: esp. trunk stabilization
‣

💬

relaxation, stretching, strengthening, trunk stabilization

• later: paravertebral, pelvic, abdominal + quadrizeps muscle
2. Massage → esp. subacute + chronic LBP
3. Posture/Pull-ups → only if Ø fracture/radiculopathy
4. Back schools → teach posture
5. Thermal + electro (low, medium freq, laser, US)

acute stages

• Patient education and exercise are the most effective treatments for chronic nonspecific low back pain (LBP).
• Kinetotherapy can be conducted at home, individually or in groups, using various exercise protocols.
• Toning exercises target deep back muscles and the transverse abdominal muscle.
• Therapeutic exercises reduce pain intensity and disability in the long term.
• Cognitive behavioral therapy provides short-term relief.
• Combined stretching and toning exercises are preferred, but no standardized protocol exists.
• Dynamic Iumbar stabilization exercises are effective for chronic upper back pain (UBP).
• Isometric contractions and controlled limb movements are part of the exercise routine.

Can also be used!

i.e. salted water (+thalassotherapy) + mud

3

FUNCTIONAL RECOVERY (selfcare + mobility)

neuroplasticity → rehab can be done in every period (not only in first 3 months)

‣

💬

⇒ Re-learing ADL + IADL

F → other way around

UPPER LIMB = WORSE

⇒ Functional independance Measure (FIM)📷

T

(Diaschisis is a Greek word meaning ‘shocked throughout.’ The term was applied medically and scientifically by Von Monakow to describe dysfunction at sites remote from, but connected to, the site of injury or insult.)

1. protect skin (tegmentum) + prevent decubitus
2. maintain the function (trophicity) of somatic structures
3. maintain joint mobility
4. prevent harmful posture/contractions

24-48h

Exercise (adjusted to stage) + occupational

ACTIVE

Brunnstrom, Bobath + Rood technique

1. Neuromuscular electric stimulation → plasticity in spinal cord
2. Constrict-induced movement therapy (↑use of upper limb at least 6h/d)
3. Special equipment: hemichair, pyramid canes, hand splint, hemi-sling
1. lower limb orthosis → FILM WALKING 📷
4. Changes to house/kitchen/houshold items
5. learning 1 hand techniques 📷
6. Robot assisted therapy

1. Thermotherapy
‣

Before what should thermotherapy performed?

before exercise therapy → joint mobility

(circulatory, vasodilation, relax)

2. Mobilization / Exercise
‣
What are the 9 things you wanna improve with exercise therapy?
1. mobility (joint)
‣

In the on-stage of the disease exercises are aimed to improve [...].

movement speed + coordination (2)

‣

In the off-stage of the disease exercises are aimed to improve [...].

starting movement

(akinesia is dominant is this stage)

2. Movement speed + coordination + Gait
‣

how can you ↑movement speed?

MOTIVATION!

music, clapping, vocal re-inforcement

‣
how can you ↑ coordination?
• Axial-peripheral and peripheral-axial-peripheral exercises
• Trunk rotation concomitant with arm movements or steps
• Exercises with the ball, with sticks, associating lower limb movements
• Walking exercises with upper limb swinging
• Walking exercises following routes on the floor
‣

You only to gait exercises when the patient is [...].

stable on feet

3. Balance
‣

how can you ↑ balance?

Stimulation of balance reactions

Example: patient standing between two parallel bars, with the head forward → Slight pushes in different directions to disrupt static balance → Techniques to facilitate stability

4. Transfers
‣
What is meant by that?
• Postural reflexes: Tonic postural reflexes facilitate the transition between different positions, such as dorsal decubitus to sitting position and sitting position to standing position.
• Cervical spine flexion: Flexion of the cervical spine helps in transitioning from dorsal decubitus to the sitting position.
• Cervical spine extension: Extension of the cervical spine aids in changing from the sitting position to the standing position.
5. Breathing re-education
‣

💬

Walking is initiated when the patient achieves stability in the standing position, requiring them to overcome a challenge commonly known as "the first step obstacle.”

6. Facial expressions
‣
💬
• Facial muscle relaxation exercises: Perform exercises in front of a mirror to relax facial muscles.
• Analytical exercises: Focus on specific areas such as the forehead, eyebrows, eyes, cheeks, and mouth.
• Global exercises: Engage in exercises that involve expressions of laughter, crying, and anger.
3. Massage
‣

Which 2 kinds of massage are mainly used in parkinons?

effleurage (light pressure/ smoothing) + vibrations

ASAP → avoiding/delaying abnormal movement patterns

Stage 3: gradual use of injured area (pain-based controll) 📷

Stage 4: Reha Tx → restore full ROM + muscle strenght+flexibility

myocardial mass + tension

• Maximal oxygen uptake (V02 max) reflects a patient's aerobic physical capacity and influences their submaximal resistive workload during exercise training.
• Uptake/beat is the volume of blood pumped per beat and is inversely related to heart rate. It is directly related to venous return and blood flow volume.
• Heart rate is the number of myocardial contractions per unit of time and is linearly related to oxygen uptake. Influencing factors include exercise type, patient's position, health, blood volume, sinus node function, medication, environment, and age.
• Myocardial oxygen consumption (MV02) depends on myocardial mass and tension, indicating force generated during myocardial contraction. It is directly related to ventricular pressure and diameter and inversely related to ventricular wall thickness. Influencing factors include blood pressure, heart rate, ventricular tension, fiber shortening range, and venous return.
• During isotonic contraction, left ventricular load increases, uptake/beat and oxygen uptake increase, and diastolic blood pressure remains unchanged while diastolic volume increases.
• Resistive exercises include both isometric and isotonic weight lifting exercises. Thorough patient screening is necessary, and correct exercise technique should be taught. Initial exercises may focus on thoracic extension, shoulder exercises, arm flexion and extension, lumbar extension, lifts, and knee and leg extension.

metabolic equivalent (MET) → quantification “how much + how hard”

• Specific cardiac disease (i.e. MI, unstable AP etc, HF)
• PE + DVT
• severe non-cardiac disorder
• severe disability
‣
💬
• Acute myocardial infarction (AMI) or recent EKG-monitored modifications
• Unstable angina pectoris (AP)
• Severe cardiac arrhythmias
• Acute pericarditis
• Endocarditis
• Severe aortic stenosis
• Severe left ventricle dysfunction
• Acute pulmonary embolism or pulmonary infarction
• Any severe non-cardiac disease
• Severe disability
• Lower extremity venous thrombosis

700-2k

1. Targed HR
‣

How can you determine target HR?

Target heart rate = 60-80% of heart rate reserve

= (HRmax - HRrest) x 0,6 + HRrest

(HR max = 220-age)

2. MET methode (measure VO2max):

For instance, if a patient's VO2max is 10 METs, the maximum exercise intensity can be set between 6-8 METs.

use questionaires

→ Duke aktivity status index 📷

→ Veterean’s specific acitvity questionaire 📷

30min