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How do you move forward in Rehab?. Function in rehab = patterns of motion that use multiple joints acting with various axes
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1. Functional Progressions & Functional Testingin Rehabilitation
2. How do you move forward in Rehab? Function in rehab = patterns of motion that use multiple joints acting with various axes & in multiple planes
Essential part of rehab that places tissues under stresses that return tissues to levels of full activity
Places stresses & forces on each body system
Traditional rehab techniques often stress only single joints in single planes of motion
To complement traditional rehab, you can use functional rehab to ready your patient for activity
3. Functional Progression Functional progression = succession of activities that simulate actual motor & sport skills
Enables the patient to acquire or reacquire the skills needed to perform activity
Must be able to adapt rehab to the sport-specific demands & specific position
The clinician breaks down the activities into individual components.
The patient can focus on each specific part of an activity.
4. Benefits for Using Functional Progression Helps patient reach goals of entire program
Goals of functional progression:
Restoration of joint ROM
Restoration of strength
Restoration of proprioception
Restoration of agility
Restoration of confidence
Provides both physiological & psychological benefits to the patient
5. Benefits for Using Functional Progression Improves functional stability
Muscular strength – SAID principle
Endurance – muscular & cardiorespiratory
Flexibility – elongating tissue to proper length
Muscle relaxation – reduce muscle tension
Motor skills – coordination & agility, automatic reactions
6. Psychological & Social Considerations Anxiety – uncertain about future
Deprivation – losing contact with team & coaches
Apprehension – precursor to re-injury
Success of activity gives confidence & motivates to attain the next goal
7. Components of a Functional Progression Phase 1 – Acute Injury Phase
Focus on restoring joint ROM, muscular strength, & muscular endurance
Phase 2 – Repair Phase
Focus on incorporating proprioception & agility exercises
Phase 3 – Remodeling Phase
Focus on restoring everything to pre-injury status
Progression should allow for planned sequential activities that challenge the athlete while allowing for success
8. Activity Considerations Principles for activity selection
Individuality of athlete, sport and injury
Should be positive (no increase in symptoms should occur)
Orderly progressive program should be utilized
Variety – avoid monotony, but don’t cause confusion
Vary exercise techniques used
Alter the program at regular intervals
Maintain fitness base to avoid re-injury with return to play
Set achievable goals, reevaluate, & modify regularly
Use clinical, home, & on-field programs to vary activity
9. Activity Considerations Make sure the patient understands the rehab process
You need to emphasize the importance of sport-specific activities to enhance the patient’s return
Incorporate the inherent demands of the sport
Physical & athletic fitness should be merged to maximize athlete response & return to previous levels
10. Designing a Functional Progression No cookbook method
You are only limited by creativity
Should be initiated early in progression
Guidelines
Evaluate the patient’s current status
Review expectations of the patient and physician
Do they work together?
Understand demands of sport and position played
May require incorporation of athlete, coach and other athletic trainers
Analyze demands that will be placed on athlete (rank order)
Set goals and means to assess levels of function and progress
Set parameters for return to play criteria
11. Components of Physical Fitness & Athletic Fitness
12. Full Return to Play Decision requires full evaluation of athlete’s condition
Objective observation and subjective evaluation
Athlete should feel ready physically and mentally
Controlled return
Added stress to injury can slow healing and result long and painful recovery or re-injury
Criteria
Physician’s release
Pain free, no swelling
Normal ROM, strength
Completion of functional testing minus adverse effects
13. Functional Testing Patient performs certain tasks appropriate to the stage in the rehab process in order to isolate and address specific deficits
Purpose for functional testing
Determines risk of injury due to limb asymmetry
Provides objective measures of progress
Measures ability of individual to tolerate forces
Used as an indirect measure of strength and power
Functional tests serve as good correlation to functional ability
Utilize valid and reliable tests
Should look at both unilateral & bilateral function
Allows clinician to determine if athlete is compensating
Must consider stage of healing, appropriate rest & self-evaluation
14. Functional Testing Limitations of functional testing
Might be limited due to lack of availability of normative values or pre-injury baseline values for comparison - subjective decisions must be made based on test results
E.g.: BESS
If normative data/pre-injury status is available objective decisions can be made
Functional test should be easily understood by athletic trainer & patient
Must consider cost efficiency, time and space demands
15. Examples of Functional Progression & Testing The Upper Extremity Possible functional activities that can enhance upper extremity performance
PNF, swimming, pulley machines, rubber tubing
All can be used to simulate sports activity
Must focus on proprioception & neuromuscular control
Awareness of proprioception
Dynamic stabilization restoration
Preparatory and reactive muscle facilitation
Replication of functional activities
Kinesthesia training can use similar activities
Requires removal of external cues
16. Promotion of joint position sense
Activities that can be used
Isokinetic exercise
Proprioception testing devices
Goniometry
Electromagnetic motion analysis
Can be practiced with visual cue progressing to no cues
Activities can be active or passive
Can also work to reproduce specific paths of motion to increase functional component of activity
Must stress joint at both ends of ROM and at mid-range
Results in capsuloligamentous afferents & musculotendinous mechanoreceptors, respectively
Dynamic stability
Stresses the training of force couples provided by scapula stabilizers & muscles of the glenohumeral joint
CKC exercises enhance co-activation
17. Preparation and Reaction
Incorporates rhythmic stabilization activities along with CKC exercises
Rhythmic stabilization prepares athlete for motion and improves muscle stiffness while training for reaction
Plyometrics are an excellent alternative activity
Functional Activities
Stress sports specific skills
PNF patterns can be used as early alternative to sports specific activity (more function, less stress)
Program should focus on core, scapulothoracic stabilizers and the glenohumeral joint
Quadruped position allows athlete to work muscles of trunk/core and upper extremity
18. While most activities are OKC oriented, CKC activities are important for restoration of proper function
Throwing Progression
Instruct athlete in complete an appropriate warm-up
Should incorporate throwing motion practice (slow velocity with low stress)
Progress through increasingly difficult stages
Shoulder serves as template for upper extremity rehabilitation and progression
Many of the activities for the shoulder are equally effective for the elbow, wrist and hand
19. Functional Testing for the Upper Extremity Timed performance is simplest & most common means used for testing
Velocity
Controlled environment (indoors to decrease effect of weather)
Set up a standard pitching distance (60’6”)
Have athlete use a wind-up motion
Measure a maximum of 5 throws measured in mph with radar gun (if no radar gun – use stop watch)
Compute the mean and compare to pretest values
CKC Upper Extremity Stability Test
Use sports specific drill to assess performance & readiness
20. Progression for the Lower Extremity Utilizes same basic pattern as upper extremity
Can use sprint times, agility runs for time, hopping (height and distance), co-contraction tests, carioca runs and shuttle runs
Sprint test
Set distance
Run the distance for time
3-5 sprints should be completed and the mean computed
Pre-test and post-test measures are compared
21. Agility test
Same premise as sprint test
Difference involves the course
Not just straight ahead running
Incorporates changes in direction, acceleration, deceleration, starts & stops
Other agility tests
Box runs
Zigzag runs
Cutting maneuvers
Figure 8 runs
Back pedaling drills
Changes in shape and size can make drills more difficult
22. Vertical Jump
Record height athlete is able to jumps (3-5 trials)
Test can also be varied
Bilateral jump vs. Single leg jump
Countermovement vs. static squat start
Approach step vs. stationary start
Upper extremity use for propulsion vs. restricted use
Co-Contraction Semicircular Test
Athlete moves about a semicircular pattern while tethered to taut Theraband using a forward facing shuffle
Athlete will complete 3 trials of 5 repetition for time
Provides a dynamics pivot shift for the ACL insufficient knee
23. Hopping Test
Single leg hop for distance
Timed hop test (ability to hop 6 meters for time)
Triple hop for distance (distance covered in 3 consecutive hops
Crossover hop (distance covered in 3 hops)
Carioca Test
Run performed for time
Run a total of 80 feet, 40 feet to the right and 40 feet to the left, both facing the same direction
Record 3 trials and calculate a mean
Shuttle Run
Four 20 feet sprints (with 3 direction changes)
Suicide sprints – sprint, touch mark and return to starting position (total time to complete drill)
24. Balance Test
Helps determine deficits in proprioception and balance
Single leg stance (hold position for time)
Can incorporate different surfaces, and eye condition
May also incorporate sports skills into test
Functional Hop Test (See handout)
Subjective Evaluations
Incorporation of subjective questionnaires or numeric scales to assess function