PAEDIATRIC PHYSIOTHERAPY. ALL EXAM REVISION QUESTIONS
AND CORRECT ANSWERS (ALREADY GRADED A+) (2024 UPDATE)
100% GUARANTEED
Benefits of continuing to exercise on MS, oedema, fitness etc. thought to outweigh heat risk, can
also help relieve pelvic pain. But increase water intake, rests, monitor
Dermatology - ANSWER- Skin reacts to water in a time-dependent manner > 3 hours greatly
increases trans epidermal water loss (TEWL)
Water disrupts intracellular lipid spaces with changed epidermal barrier, increases permeability
and lowers threshold for release of cytokines
Higher susceptibility to irritants *for 24 hours
All = dry skin = increased changes of trauma, irritation, dermatitis
Pool disinfectants common skin irritants
Skin care in the pool - ANSWER- Limit length of water exposure and temperature
Avoid soap and soap-based body wash
Shower <5 minutes in tepid water
Moisturise - reduced TEWL, smooth skin surface by filling in gaps and strengthening epidermal
barrier - at least once per day, ideally after bathing
Barrier cream prior to pool entry if skin issues
,Exercise choices in the pool - ANSWER- Consider principles of immersion and properties of
water .
Consider safety for each type of exercise and set up
Think about goals of exercising in pool vs. on land
ROM/stretching - ANSWER- Conflicting evidence about effect of heat = more relaxed, feel
more supported, pressure input = may be able to go further into range
Can be a good environment to stretch when warm, relaxed
Need to set up to isolate and stretch desired muscle group
Consider using floats to use buoyancy to assist
CV exercise - ANSWER- Pool can be a greater environment for CV exercise due to fact that
CO is increased and lung volumes are decreased
Buoyancy and decreased WB in water means less loading on LL, so increased intensity of exercise
can be done
UL exercise load can be increased with principles of drag and turbulence
Kicking, swimming, aqua aerobics, running, repetitive arm exercises, jumps, treading water
Strengthening - ANSWER- Less WB = less load for functional exercise
Good for very weak patient, but unsure if relevant for functional walkers - think about progressing
strengthening in the pool.
,PROGRESS: decrease depth of exercise/single leg, increase speed (increased load from
turbulence), increase SA of moving part (increased load from turbulence), change effect of
buoyancy, increase reps and sets
Stability required to isolate and strengthen appropriately
Pool is inherently a more unstable environment: more core control needed to stabilise
So consider need to hold onto side of pool, stand is shallower water to isolate desired muscle group
vs. increasing the challenge and stability needed when strengthening
Strengthening and buoyancy - ANSWER- Buoyancy assisted exercises use the buoyancy of the
water to assist a movement (floating up)
Buoyancy counter balance - exercise aims to move without the effects of buoyancy (across parallel
to surface of water) - eliminating effect of gravity
Buoyancy resisted - require exercise to involve moving down against the force of buoyancy
Strengthening: EVIDENCE - ANSWER- Agonists and antagonists are active in differing
amounts and depending on how the instructions are given
Single, maximum speed and effort seated knee extension showed more quads activation and
minimal hamstrings
Repetitive knee flexion/extension showed high antagonist activation early in range - can be good
if goal is to improve stability around joint and wanting co-contraction e.g. Knee or shoulder post
ACL or improving multi-direction movement.
For isolating contraction: perform slowly, wait for water to settle between F/E
, Equipment - ANSWER- Can be used to increase load or support the body or a segment
Kickboards
Dumbbells
Paddles
Ankle cuffs (weights or floats)
Steps, seats, stairs
Beanie floats
Walking in water - ANSWER- Comfortable walking speed in water 2.7 times slower than on
land
Walking in water uses SAME PATTERN as on land
Muscles torques required at ankle and knee extension were reduced, knee and ankle offloaded
more than hip
Muscle torques at hip and knee flexion similar
Walking at comfortable speed in water may offload ankle and knee more than hip
In backwards: more activation of paraspinal muscles - have to try and hold trunk may
Need to measure speed of walking and record depth of walking
Need to walk fast if want to strengthen knees and ankles
AND CORRECT ANSWERS (ALREADY GRADED A+) (2024 UPDATE)
100% GUARANTEED
Benefits of continuing to exercise on MS, oedema, fitness etc. thought to outweigh heat risk, can
also help relieve pelvic pain. But increase water intake, rests, monitor
Dermatology - ANSWER- Skin reacts to water in a time-dependent manner > 3 hours greatly
increases trans epidermal water loss (TEWL)
Water disrupts intracellular lipid spaces with changed epidermal barrier, increases permeability
and lowers threshold for release of cytokines
Higher susceptibility to irritants *for 24 hours
All = dry skin = increased changes of trauma, irritation, dermatitis
Pool disinfectants common skin irritants
Skin care in the pool - ANSWER- Limit length of water exposure and temperature
Avoid soap and soap-based body wash
Shower <5 minutes in tepid water
Moisturise - reduced TEWL, smooth skin surface by filling in gaps and strengthening epidermal
barrier - at least once per day, ideally after bathing
Barrier cream prior to pool entry if skin issues
,Exercise choices in the pool - ANSWER- Consider principles of immersion and properties of
water .
Consider safety for each type of exercise and set up
Think about goals of exercising in pool vs. on land
ROM/stretching - ANSWER- Conflicting evidence about effect of heat = more relaxed, feel
more supported, pressure input = may be able to go further into range
Can be a good environment to stretch when warm, relaxed
Need to set up to isolate and stretch desired muscle group
Consider using floats to use buoyancy to assist
CV exercise - ANSWER- Pool can be a greater environment for CV exercise due to fact that
CO is increased and lung volumes are decreased
Buoyancy and decreased WB in water means less loading on LL, so increased intensity of exercise
can be done
UL exercise load can be increased with principles of drag and turbulence
Kicking, swimming, aqua aerobics, running, repetitive arm exercises, jumps, treading water
Strengthening - ANSWER- Less WB = less load for functional exercise
Good for very weak patient, but unsure if relevant for functional walkers - think about progressing
strengthening in the pool.
,PROGRESS: decrease depth of exercise/single leg, increase speed (increased load from
turbulence), increase SA of moving part (increased load from turbulence), change effect of
buoyancy, increase reps and sets
Stability required to isolate and strengthen appropriately
Pool is inherently a more unstable environment: more core control needed to stabilise
So consider need to hold onto side of pool, stand is shallower water to isolate desired muscle group
vs. increasing the challenge and stability needed when strengthening
Strengthening and buoyancy - ANSWER- Buoyancy assisted exercises use the buoyancy of the
water to assist a movement (floating up)
Buoyancy counter balance - exercise aims to move without the effects of buoyancy (across parallel
to surface of water) - eliminating effect of gravity
Buoyancy resisted - require exercise to involve moving down against the force of buoyancy
Strengthening: EVIDENCE - ANSWER- Agonists and antagonists are active in differing
amounts and depending on how the instructions are given
Single, maximum speed and effort seated knee extension showed more quads activation and
minimal hamstrings
Repetitive knee flexion/extension showed high antagonist activation early in range - can be good
if goal is to improve stability around joint and wanting co-contraction e.g. Knee or shoulder post
ACL or improving multi-direction movement.
For isolating contraction: perform slowly, wait for water to settle between F/E
, Equipment - ANSWER- Can be used to increase load or support the body or a segment
Kickboards
Dumbbells
Paddles
Ankle cuffs (weights or floats)
Steps, seats, stairs
Beanie floats
Walking in water - ANSWER- Comfortable walking speed in water 2.7 times slower than on
land
Walking in water uses SAME PATTERN as on land
Muscles torques required at ankle and knee extension were reduced, knee and ankle offloaded
more than hip
Muscle torques at hip and knee flexion similar
Walking at comfortable speed in water may offload ankle and knee more than hip
In backwards: more activation of paraspinal muscles - have to try and hold trunk may
Need to measure speed of walking and record depth of walking
Need to walk fast if want to strengthen knees and ankles
