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THERAPEUTIC CONCEPTS
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THERAPEUTIC CONCEPTS

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  • 1. Intro to Therapeutic Concepts Kinesiotherapy Training Module
  • 2. Kinesiotherapy’s Role• Kinesiotherapy provides a bridge between acute illness and physical wellness for persons who are medically stable but have not yet achieved maximal restoration of strength, endurance and mobility.• Kinesiotherapists are qualified to implement exercise programs designed to: • Reverse or minimize the debilitating effects of disease, injury, or prolonged illness. • Enhance functional capacity. • Restore the ability to perform daily tasks. • Develop fitness characteristics to enhance healthy and functionally independent living. 2
  • 3. Kinesiotherapy’s Role• Essential skills required: • Knowledge of normal body structures and movement patterns. • Knowledge of how pathological disease processes affects normal function.• The intervention process includes : • Development and implementation of a treatment plan. • Assessment of progress toward goals. • Modification of goals as necessary to achieve goals and outcomes, and client education. 3
  • 4. Kinesiotherapy’s Role• Kinesiotherapists must have a prescription from a qualified physician, nurse practitioner and/or physician’s assistant who has been privileged to make such referrals before administering therapeutic treatment. • Protects the patient from receiving treatment from an unqualified individual. • Protects the therapist in that safe parameters for the patient are set. • Provides other medical history, such as a pre-existing medical or surgical condition, that was not reported by the patient during the therapist’s evaluation.• In collaboration with the patient/family, the Kinesiotherapist determines the appropriate evaluation tools and interventions necessary to establish a goal-specific treatment plan. • A goal-specific treatment plan is based on anticipated outcomes for the patient. What does the patient want to accomplish? Therapeutic Concepts 4
  • 5. Kinesiotherapy’s Role• Basic guidelines for developing a rehab program include: • Establish a baseline. • Progression should be gradual and not cause excessive fatigue. • Use the overload principle. • Rhythmic/cyclic activity.• Fundamental Modalities of Kinesiotherapy: • Exercise • Education 5
  • 6. Therapeutic Concepts• Physical Fitness – the ability to complete daily activities with vigor and alertness, without undue fatigue, and with energy remaining to meet unexpected activities.• Rehabilitation – the restoration and/or maintenance of physical function to the level that allows an individual to perform activities of daily living (ADL) without incurring high levels of stress or fatigue.• Activities of Daily Living (ADL) - the basic activities of typical human life, including positioning, mobility, self-care/maintenance activities and communication; examples include dressing, using eating utensils, daily hygiene, getting up and down from a seated position, etc.• Functional Limitations – the reduced ability of a person to perform basic ADL activities in an efficient or typically expected manner. Therapeutic Concepts 6
  • 7. Components of Physical Function• Range of Motion (ROM) – the amount of angular motion allowed at the joint between any two bony levers.• Passive Range of Motion (PROM) – movement within the unrestricted ROM for a segment that is produced entirely by an external force.• Active-Assistive Range of Motion (AAROM) – movement through a ROM that is completed by a voluntary muscle contraction along with the assistance of an external force.• Active Range of Motion (AROM) – movement within an unrestricted ROM that is produced by an active contraction of the muscles crossing that joint. Therapeutic Concepts 7
  • 8. Components of Physical Function• Balance – the ability to maintain the body’s center of gravity over the base of support. • Static - the ability to hold a position without moving (ex. standing on one leg). • Dynamic - the ability to maintain equilibrium while moving through space (ex. walking or running).• Proprioception – perception of movement direction, amplitude, speed, and tension based on information from tendon and muscle receptors, joint receptors, and the vestibular system.• Kinesthesia – awareness of weight, position, and movement of the body; includes position sense (static position awareness); also from joint, muscle and tendon receptors.• Flexibility – the ability of muscle and other soft tissue to yield to a stretch force. Therapeutic Concepts 8
  • 9. Components of Physical Function• Coordination – the basis of smooth, efficient, and accurate movement that results from using the appropriate muscles at the appropriate time with the correct intensity.• Muscular strength - the greatest measurable force that can be exerted by a muscle during a single, maximum effort • The relative strength of a muscle is represented by its ability to produce a tension force in response to the demands placed on it • Example – a maximum bench press, squat, deadlift.• Muscular endurance - the ability of a muscle to: • Resist fatigue during sustained contractions or repeated repetitions. • Generate and sustain tension for an extended period of time • Example – performing continuous reps of bench presses (16 or higher) with a fixed resistance. Therapeutic Concepts 9
  • 10. Components of Physical Function• Muscular power - work produced by a muscle per unit of time (force x distance/time). • Muscle power relates to the strength and speed of muscle performance. • The greater the intensity of an exertion, the shorter the period of time taken to generate the force, the greater the power output. • Example - jumping movements, throwing movements. • Cardiopulmonary Fitness – the ability of the heart and lungs to take in and transport adequate amounts of oxygen to the working muscle, allowing activities that involve large muscle groups to be performed over long periods of time. Therapeutic Concepts 10
  • 11. Components of Physical Function• Cognition - refers to the mental processes involved in gaining knowledge and comprehension, including thinking, knowing, remembering, judging and problem solving. • These are higher-level functions of the brain. • Includes short and long term memory, language, imagination, perception, orientation, attention span, and planning.• Sensation – the ability to perceive touch, temperature, pain, vibration.• Hearing - perception of sound by conversion of sound waves and/or vibration into nerve impulses. Therapeutic Concepts 11
  • 12. Components of Physical Function• Vision – the act or power of sensing with the eyes. • Includes visual acuity, depth perception, color vision, and peripheral vision.• Mobility – the ability to move in a variety of directions and carry out both simple and complex motor tasks. • Normal - the ability to move in ones environment with ease and without restriction. • Impaired - any limitation in independent, purposeful physical movement of the body of one or more extremities. Therapeutic Concepts 12
  • 13. Components of Physical Function• Posture – position of the body or body parts. • Proper or neutral – normal spinal curves; the ears, shoulders, hips, knees and ankles aligned as if a plumb line were running through them. • Kyphosis – exaggeration of the posterior thoracic curve. • Lordosis – exaggeration of the anterior cervical or lumbar curve. • Scoliosis – lateral “S” or “C” curvature of the spine.• Postural Control • Equilibrium Reactions – reflexive reactions that enable a person to maintain or regain balance during a shift in the center of gravity. • Righting Reactions – the use of visual and vestibular input and processing to place the head in correct position to maintain vertical alignment of the head in relation to gravity. Therapeutic Concepts 13
  • 14. Components of Physical Function• Pain – an unpleasant sensation induced by a noxious stimulus, received by nerve endings and characterized by physical discomfort (ex. pricking, throbbing, burning or aching). • Occurs in varying degrees of severity, often as a consequence of injury, disease, or emotional disorder. • Can lead to physical, psychosocial and/or psychological distress.• Acute Pain - sudden onset pain, that can be mild and last for a moment, or be severe and last weeks or months; in most cases it does not last longer than six months, and disappears when the underlying cause has been treated. • Primary goal of acute pain treatment is to diagnose the source and remove it, since unrelieved acute pain can lead to chronic pain. Therapeutic Concepts 14
  • 15. Components of Physical Function• Chronic pain - generally starts as acute pain, but continues beyond the normal time expected for resolution of the problem. • Can be mild or excruciating, episodic or continuous, merely inconvenient or totally incapacitating. • Nociceptive – arises from damage to tissues other than nerve fibers • Neuropathic – occurs when nerves in the central nervous system become injured, dysfunctional or damaged; often described as a burning, stabbing, or tingling pain. • Primary goals of treatment are to minimize pain and maximize function. • Idiopathic pain – pain for which a reasonable cause cannot be determined. Therapeutic Concepts 15
  • 16. Tests and Measurements• Vital Signs - measures of various physiological processes used to assess the most basic body functions; generally consist of blood pressure, heart rate, respiratory rate and body temperature. • Heart Rate (HR) – determined by the number of heartbeats per unit of time, typically expressed as beats per minute (BPM). • Normal resting heart rate ranges from 60 to 100 beats a minute in a healthy adult. • Many factors can influence heart rate, including: activity level, fitness level, air temperature, body position (ex. standing , lying down), emotions, body size, and/or medication use. • Used to evaluate readiness for, as well as response to, exercise or activity; best taken pre-, during and post-exercise. • Can be measured at carotid, wrist, temple, elbow, or foot. Therapeutic Concepts 16
  • 17. Tests and Measurements• Vital Signs (cont.)• Blood Pressure (BP) - the force applied to the walls of the arteries as the heart pumps blood through the body. • Pressure is determined by the force and amount of blood pumped, and the size and flexibility of the arteries. • Can be affected by activity, temperature, diet, emotional state, posture, physical state, medication use. • Measured on the anteromedial aspect of the elbow at the brachial artery. • Systolic reading - the maximum pressure exerted when the heart contracts; normal reading less than120mmHg. • Diastolic reading - the minimum pressure in the arteries when the heart is at rest; normal reading less than 80mmHg. Therapeutic Concepts 17
  • 18. Tests and Measurements• Blood Pressure (cont.) • Hypotension – low BP; of concern if symptomatic (lightheadedness, dizziness, weakness or fainting). • Hypertension –high BP; a consistently high blood pressure exceeding 140/90mm/Hg. • Orthostatic hypotension – a significant drop in pressure following a change in body position resulting in low BP symptoms. Seen most often when moving from lying to sitting or sitting to standing.• Respiratory rate - number of breaths taken within a set amount of time. • Average respiratory rate at rest for a healthy adult is usually given as 12-18 breaths per minute. • Note whether a person has any difficulty breathing. Therapeutic Concepts 18
  • 19. Tests and Measurements• Pulse Oximetry – a non-invasive method for monitoring the oxygenation of a patients hemoglobin. • Only measures oxygenation, not ventilation and is not a complete measure of respiratory sufficiency. • Normal range - 95-99. • Abnormal – less than 89.• Goniometer – a protractor with two extending arms that measures joint range of motion.• Pivot point is placed over the axis of the joint.• Arms are placed along the long axis of the bones. Therapeutic Concepts 19
  • 20. Tests and Measurements• Inclinometer – a device used to measure the range of motion of the spine. • Measures angular displacement relative to gravity as opposed to arcs like a goniometer. • Inclinometers are used because the spine is composed of multiple joints that function in unison to produce movement. A goniometer cannot distinguish the difference between hip flexion, sacral flexion or lumbar flexion when the subject is bending forward. Therapeutic Concepts 20
  • 21. Tests and Measurements• Scoliometer – used to detect lateral spinal curvature (scoliosis).• Flexometer – 360° gravity-type goniometer that is self-zeroing; straps to body parts. Therapeutic Concepts 21
  • 22. Average Ranges of Motion for the Upper Extremities (in degrees from selected sources)Joint Motion American Acad Kendall and American of Orthopedic McCreary Medical Assoc SurgeonsShoulder Flexion 0–180 0-180 0–150 Extension 0-60 0–45 0-50 Abduction 0-180 0-180 0-180 Medial Rotation 0-70 0-70 0-90 Lateral Rotation 0-90 0-90 0-90Elbow Flexion 0-150 0-145 0-140Wrist Extension 0-70 0-70 0-80 Flexion 0-80 0-80 0-60 Radial Deviation 0-20 0-20 0-20 Ulnar Deviation 0-30 0-35 0-30 Therapeutic Concepts 22
  • 23. Average Ranges of Motion for the Lower Extremities (in degrees from selected sources)Joint Motion American Acad Kendall and American of Orthopedic McCreary Medical Assoc SurgeonsHip Flexion 0-120 0-125 0-100 Extension 0-30 0-10 0-30 Abduction 0-45 0-45 0-40 Adduction 0-30 0-10 0-20 Lateral Rotation 0-45 0-45 0-40 Medial Rotation 0-45 0-45 0-50Knee Flexion 0-135 0-140 0-150Ankle Dorsiflexion 0-20 0-20 0-20 Plantarflexion 0-50 0-45 0-40 Inversion 0-35 0-35 0-30 Eversion 0-15 0-20 0-20 Therapeutic Concepts 23
  • 24. Average Ranges of Motion for the Spine (in degrees from selected sources)Joint Motion American Acad Kendall and American of Orthopedic McCreary Medical Assoc SurgeonsCervical Flexion 0-45 0-45 0-60 Extension 0-45 0-45 0-75 Lateral Flexion 0-45 0-45 Rotation 0-60 0-80Thoracic Flexion 0-50 Rotation 0-30Thoracic/ Flexion 0-80Lumbar Extension 0-25 Lateral Flexion 0-35 Rotation 0-45Lumbo- Extension 0-25Sacral Lateral Flexion 0-25 Therapeutic Concepts 24
  • 25. Tests and Measurements• End-Feel – a quality of resistance and/or sensation that is felt by the examiner at the end point of the available range of motion. Each joint has a normal end feel.• Pathology is indicated when there is an incorrect end-feel at the terminal range, or a correct end-feel before the terminal range.• Passive range of motion should be used prior to performing a manual muscle test, to determine if range is restricted, since the MMT grading scale is based on the completion of the range of motion. Therapeutic Concepts 25
  • 26. Normal (Physiological) End-FeelsEnd-feel Structure ExampleSoft soft tissue approximation knee flexion (contact between the soft tissue of the posterior leg and thigh)Firm muscular stretch hip flexion with the knee straight (passive elastic tension of hamstring muscles) capsular stretch extension of metacarpophalengeal joints (tension in the anterior capsule) ligamentous stretch forearm supination (tension in the ligament in the inferior radioulnar joint)Hard bone contacting bone elbow extension (contact between the olecranon process and olecranon fossa) Therapeutic Concepts 26
  • 27. Abnormal (Pathological) End-FeelsEnd-feel ExamplesSoft Occurs sooner or later in the ROM than is usual, soft tissue edema or in a joint that normally has a firm or hard end- synovitis feel; feels boggyFirm Occurs sooner or later in the ROM than is usual, or increased muscular tonus in a joint that normally has a soft or hard end-feel capsular, muscular, ligamentous shorteningHard Occurs sooner or later in the ROM than is usual, or chondromalacia, OA, loose in a joint that normally has a soft or firm end-feel bodies in the joint, fx, myositis ossificansEmpty No real end-feel because pain prevents reaching acute joint inflammation, the end of ROM; no resistance is felt except the bursitis, abscess, fx patient’s protective muscle splinting or muscle spasm Therapeutic Concepts 27
  • 28. Tests and Measurements• Manual Muscle Test (MMT) – assesses the extent and degree of muscular weakness resulting from disease, injury or illness. • Unaffected limb/side should be tested first – allows the tester to learn what would be considered normal for that person. • Proper positioning is essential for validity. • Muscles and tendons should be palpated as a lack of tension helps identify substitution by muscles other than the those being tested. • Fatigued muscles should not be confused with weak ones. • Grading system – system for recording results of manual muscle test. • Several methods of recording exist. • Considered to have both subjective and objective factors. Therapeutic Concepts 28
  • 29. Tests and Measurements• MMT Grading System • Normal or 5 or 100%– complete range of motion against gravity with full resistance. • Good or 4 or 75% – complete range of motion against gravity with some resistance. • Fair or 3 or 50% – complete range of motion against gravity. • Poor or 2 or 25% – complete range of motion with gravity eliminated. • Trace or 1 or 5-10% – evidence of slight contractility, but no joint motion. • Zero or 0 or 0% – no evidence of contractility. Therapeutic Concepts 29
  • 30. Tests and Measurements• Anthropometrics – measurement of body size and composition. • Can include height, weight, body fat, circumference of any body segment, and arm span.• Sit and Reach – measures hip, low back and hamstring flexibility.• Thomas Test – physical exam used to rule out a hip flexion contracture.• Subject lies supine on the exam table; examiner passes a hand beneath the person’s spine to identify lumbar lordosis.• Unaffected hip is flexed until the thigh just touches the abdomen to eliminate the lumbar lordosis.• Angle between the affected thigh and the table is measured to detect any fixed flexion deformity of the hip. Therapeutic Concepts 30
  • 31. Tests and Measurements• Adams Forward Bend Test - used to screen for scoliosis. • Subject bends forward with the feet together and knees straight while dangling the arms; examiner stands behind subject, looking for differences in rib cage height, or other deformities of the back. • Get Up & Go – mobility test to assess risk for falls. • Used mainly for the elderly population. • Person must be able to walk independently with or without an assistive device. • A timed test that requires the individual to rise from a chair, stand momentarily, walk 10 ft, turn around, walk back to the chair, turn around and sit in the chair. Therapeutic Concepts 31
  • 32. Tests and Measurements• Cardio/Respiratory – measures the ability of the circulatory and respiratory systems to supply oxygen to skeletal muscles during sustained physical activity.• Six-Minute Walk – a self-paced test to measure functional exercise capacity; the distance a person can walk on a flat, hard surface in a period of 6 minutes.• Leg length discrepancy – measure the length of each lower limb from the anterior superior iliac spine to the medial malleolus; compare for differences. Therapeutic Concepts 32
  • 33. Tests and Measurements• Trendelenberg Sign – used to detect weak hip abductors, including gluteus medius and minimus. • Subject stands with feet shoulder width apart, lifts one foot • Test is positive when the non weight-bearing limb shows pelvic drop; indicates the hip abductors on the weight-bearing limb are weak and cannot stabilize the pelvis.• Electromyography – the measurement and analysis of muscle action potential using surface or needle electrodes. Therapeutic Concepts 33
  • 34. Therapeutic Interventions• Therapeutic Exercise – the systematic and planned performance of bodily movements, postures, or physical activities to: • Remediate or prevent impairments. • Improve, restore, or enhance physical function. • Optimize overall fitness and health status.• Four main types of therapeutic exercise: • Passive – movement that is a result of an outside force. • Active Assistive – some if not most of movement is assisted by an outside force. • Active – movement is performed without assistance. • Resistive – movement is performed against an outside force. Therapeutic Concepts 34
  • 35. Therapeutic Interventions • Codman’s or Pendulum Exercise –gravity assisted exercises for restoring range of motion and function in the arm or shoulder.• Performed by swinging a freely hanging upper extremity in a pendulous fashion• Incorporates three distinct movement patterns of the shoulder: circumduction, flexion and extension, abduction and adduction. Therapeutic Concepts 35
  • 36. Therapeutic Interventions• Bobath or Neurological Development Treatment (NDT) – a system of exercises, consisting characteristically of reflex-inhibiting postures and maneuvers; an advanced hands-on approach to the examination and treatment of individuals with disturbances of function, movement and postural control due to a lesion of the central nervous system (CNS). • Used primarily with children who have cerebral palsy (CP) and adults with cerebral vascular accidents (CVA). • Rehabilitation goals - to improve any or all of the following: postural control, coordination of movement sequences, movement initiation, optimal body alignment, abnormal tone or muscle weakness. Therapeutic Concepts 36
  • 37. Therapeutic Interventions• Proprioceptive Neuromuscular Facilitation (PNF) - a system for promoting the response of neuromuscular mechanisms by stimulating proprioceptors. • Designed in the 1940s and 1950s by Kabat, Knott and Voss to rehabilitate polio or other patients with paralysis. • PNF techniques involve placing a demand where a response is required. • Specific parts of the body are stabilized with the hand or body of the clinician, while the other hand is used to grip the extremity or relevant part of the limb of the patient to offer highly specific patterns of resistance. Therapeutic Concepts 37
  • 38. Therapeutic Interventions• DeLorme Exercises - progressive resistance exercises usually called PRE, in which the loads to be lifted increase progressively during one session as well as during the course of training.• Weight Bearing Exercise - an activity or exercise which requires that some part of the body must resist gravity while supporting the weight of the rest of the body.• Williams Flexion Exercises - system of exercises intended to enhance lumbar flexion, avoid lumbar extension, and strengthen the abdominal musculature to manage low back pain non-surgically. • While not the original intent, these exercises also stretch the back, hip, gluteal, and hamstring musculature. Therapeutic Concepts 38
  • 39. Therapeutic Interventions• Balance exercises – improve proprioception and kinesthesis, so as to maintain both static and dynamic postures and balance.• McKenzie Method or Mechanical Diagnosis and Therapy (MDT) - more of an approach to back and neck pain rather than a specific set of exercises. • Relies on therapist assessment, an algorithm to determine condition categories that help pinpoint the mechanical source of a patient’s historical pain, and active patient involvement in the diagnosis and treatment prescription. • Involves extension exercises , specified movements and positions, and a strong focus on self treatment strategies and minimal use of manual therapy procedures. Therapeutic Concepts 39
  • 40. Therapeutic Interventions• Stretching exercises – exercises that lengthen and elongate muscles and associated soft tissues. • Static stretch - a stretch performed without joint movement where a position is assumed and then held. • Dynamic stretch - a stretch performed with joint movement where the end position is not held. • Ex. arms circles, side bends and exaggerated kicking action. • Passive (or assisted) stretch - similar to a static stretch, however another person or apparatus is used to help further stretch the muscles. • Active (or active static) stretch - a stretch where a position is assumed and then held with no assistance other than using the strength of the agonist muscle(s). Tension of the agonist helps to relax the muscle(s) being stretched (the antagonists) by reciprocal inhibition. Therapeutic Concepts 40
  • 41. Therapeutic Interventions• Postural Drainage – an airway clearance technique that uses gravity to help patients with respiratory illnesses clear mucus from the lungs. • Uses various body positions to facilitate drainage from specific lung segments. • Often used in conjunction with chest percussion and vibration. • Breathing exercises - techniques for learning to control the rate and depth of breathing. • Generally inhale through the nose, while expanding the chest, and then exhale fully through the mouth, while contracting the abdominal muscles. • Used after chest surgery, by people with chronic obstructive pulmonary disease, anxiety disorders, and asthma. Therapeutic Concepts 41
  • 42. Therapeutic Interventions• Quad Cough – a technique to help clear secretions from the airway • Generally used for patients with central nervous system disorders such as spinal cord injury who are unable to generate sufficient force to clear respiratory secretions. • After a maximal inspiration, the patient coughs while an assistant exerts gentle upward and inward pressure with both hands on the abdomen; increased intra-abdominal pressure produces a more forceful cough.• Education – essential for the proper understanding of the disease, injury, or illness and its effects, as well as the reasoning behind the treatment program, proper technique and benefits of compliance. • Can include verbal and written instruction, demonstration and mentoring. Therapeutic Concepts 42
  • 43. Medical Terminology• Antalgic – counteracting or avoiding pain, as in a posture or gait assumed so as to lessen pain.• Ataxia -partial or complete inability to coordinate voluntary movements.• Apraxia - total or partial loss of the ability to perform purposeful movements or manipulate objects in the absence of motor or sensory impairment.• Aphasia – inability to communicate due to the disturbance of both expressive and receptive language.• Aneurysm – weak bulge in an artery.• Clonus - a series of rapid involuntary muscle contractions associated with upper motor neuron lesions.• Contralateral – on or relating to the opposite side (of the body). Therapeutic Concepts 43
  • 44. Medical Terminology• Dyspnia – difficulty in breathing.• Decubitus Ulcer – skin ulceration or sore frequently caused by prolonged pressure.• Drop Foot – the dropping of the forefoot due to weakness, damage to the peroneal nerve or paralysis of the muscles in the anterior portion of the lower leg.• Dyskinesia – difficulty initiating movement.• Edema –accumulation of fluid in the tissue spaces.• Etiology – the source or origin of a symptom or disease.• Fasciculation – small, local, involuntary muscle contraction and relaxation which may be visible under the skin.• Idiopathic – unknown cause. Therapeutic Concepts 44
  • 45. Medical Terminology• Ipsilateral – on or relating to the same side (of the body).• Orthosis - an artificial or mechanical aid, such as a brace, to support or assist movement of a weak or injured body part.• Prosthesis – a device designed to replace a missing body part or to make a part of the body work better.• Syncope – fainting spell. Therapeutic Concepts 45
  • 46. Abbreviations• a - before• AAROM – active assistive range of motion• Abd - abduction• ACL – anterior cruciate ligament• Add - adduction• ADL – activities of daily living• AFO – ankle foot orthosis• AK – above knee• AROM – active range of motion• BID, TID,QID – 2x/day, 3x/day, 4x/day• BK – below knee• BPH – benign prostatic hypertrophy Therapeutic Concepts 46
  • 47. Abbreviations• c - with• CA – cancer• CABG – coronary artery bypass graft• CAD – coronary artery disease• CCU – coronary care unit• CHD – congestive heart disease• CHF – congestive heart failure• CKC – closed kinetic chain - ??? thoughts• c/o – complains of• COPD – chronic obstructive pulmonary disease• CP – cerebral palsy• CPM – continuous passive motion Therapeutic Concepts 47
  • 48. Abbreviations• CS – cervical spine• CT – computerized tomography• CVA – cerebral vascular accident• D/C – discharge• DDD – degenerative disc disease• DM – diabetes melitis• DVT – deep vein thrombosis• Dx – diagnosis• EKG/ECG – electrocardiogram• EMG – electromyogram• ERP – end range pain• FWB – full weight bearing Therapeutic Concepts 48
  • 49. Abbreviations• Fx – fracture• GM&S – general medical and surgical• HEP – home exercise program• HNP – herniated nucleus pulposus• HTN – hypertension• Hx – history• ICU – intensive care unit• ISOM – isometric• Jt – joint• LBP – low back pain Therapeutic Concepts 49
  • 50. Abbreviations• LE, UE – lower extremity, upper extremity• LS – lumbar spine• MI – myocardial infarction• MMT – manual muscle test• MS – multiple sclerosis• MVA – motor vehicle accident• N/A – not applicable• NPO – nothing by mouth• NSC, SC – non service connected, service connected• NWB – non weight bearing Therapeutic Concepts 50
  • 51. Abbreviations• OA - osteoarthritis• ORIF – open reduction internal fixation• p - after• PMH – past medical history• PM&R – physical medicine & rehabilitation• PRE – progressive resistive exercise• PRN – as needed• PVD – peripheral vascular disease• PWB – partial weight bearing• R/O – rule out• Rx – prescription or treatment• s – without• SCI – spinal cord injury Therapeutic Concepts 51
  • 52. Abbreviations• SLR – straight leg raise• SOB – shortness of breath• S/S – signs and symptoms• Sx – surgery• THA – total hip arthroplasty• TIA – transient ischemic attack• TKA – total knee arthroplasty• TTWB – toe touch weight bearing• TURP – transurethral prostatectomy• UTI – urinary tract infection• WNL – within normal limits Therapeutic Concepts 52