EXAM 1 Flashcards
1
Q
goal of evidence based health care
A
to enhance recovery and improve the outcome of treatment
2
Q
4 aspects of evidence based health care
A
-integration of best evidence
-consideration of each patients needs
-contextualized within clinicians training and expertise
-values patients preference and values
3
Q
why for is there a need for evidence-based practice
A
-efficiently optimize treatment outcomes (dont want to do ineffective treatment)
-assessing treatments outcomes
4
Q
pyramid of quality of the article starting from the bottom
A
-background information/expert opinion
-case-controlled studies, case series, and case reports
-cohort studies
-randomized controlled trials
-critically-appraised individual articles (article synopses)
-critically-appraised topics (evidence syntheses)
-systematic reviews
5
Q
effectiveness of a research article
A
result of interventions applied during routine daily practice (did it work, correlation?)
6
Q
efficacy of a research article
A
established through randomized controlled trials (RCTs)
7
Q
5-step process of evidence based practice searches
A
1) create a clinically relevant and searchable question from your clinical experience (PICO Question)
2) conduct a database search
3) critically appraise the evidence or articles for quality
4) critically synthesize the evidence
5) assess the outcomes by monitoring the athlete
8
Q
how to format a PICO question
A
P = patient and problem
I = intervention (treatment)
C = comparison intervention
O = outcome (what do you want to get out of the intervention)
9
Q
reliability of articles
A
consistency in measures attained by people or instruments
-do you obtain the expected outcome every time?
10
Q
internal reliability
A
assess the consistency with which a person answers similar survey questions (same survey = same answer)
11
Q
test-retest reliability
A
when an instrument produces similar outcomes on repeated trials
12
Q
interrater reliability
A
agreement between different people when using or performing an assessment (same results with 2 people measuring the same patient with a goniometer)
13
Q
intrarater reliability
A
agreement of a single clinician’s reproduced measures between assessments
-assumes the instrument is reliable
14
Q
what type of reliability would be examining whether an instrument or test produces similar outcomes with repeated trials?
A
test-retest reliability
15
Q
validity
A
when a reliable measure or observation truly measures the variable of interest
-are we getting the correct answer every time?
16
Q
face validity
A
-least robust
-researched merely feels the instrument measures its intended objective
(I think that is what it is.. see it and agree?)
17
Q
content validity
A
-not robust
-researcher has others review the tool to establish consensus that it might measure an intended objective
-lacks statistical analysis
example: surveys
18
Q
criterion validity
A
-ability of an assessment or instrument to correlate with an established measure
-a novel assessment compared to a gold standard
19
Q
2 subsets of criterion validity
A
1) known-groups validity
2) predictive validity
20
Q
known-groups validity
A
when an assessment can differentiate between groups with or without a condition
-can we predict the results?
example: rapid vs lab test
21
Q
predictive validity
A
when a current assessment is highly correlated with a future criterion
22
Q
sensitivity
A
ability of a test to correctly identify a condition
-the expression of how accurately an assessment can identify a problem or illness
23
Q
specificity
A
ability of a test to correctly rule out the presence of a condition
-the expression of how accurately an assessment can identify the absence of a problem or illness
24
Q
true positives
A
occur when a test correctly identifies a condition
25
true negatives
occur when a test correctly rule out a condition
26
false positives
when an assessment indicates the presence of a condition that in real life is absent
27
false negatives
when an assessment indicates the absence of a condition that in real life is present
28
likelihood ratio
probability of having a condition
29
if a person does not have COVID-19, yet a test comes back positive this would be considered a ______ and the test would most likely have a low ______
false positive, sensitivity
30
therapeutic modality
a device or apparatus having curative powers
31
evidence-based approach
"integration of the best research evidence with clinical expertise and patient values"
32
thermal energy modality
ice packs, cold or warm water immersion
33
electrical energy modality
TENS, high-voltage, interferential currents
34
sound energy modality
ultrasound and extracorporeal shock wave therapy
35
electromagnetic energy modality
shortwave diathermy, low-level laser, infrared lamps
36
mechanical energy modality
traction, intermittent, compression devices
37
Arndt-Schultz principle
insufficient energy to stimulate target structure results in no reaction or change, too much energy is detrimental to tissue
too little does nothing, too much does more harm than good (find the happy medium)
38
Grotthus-Draper Law
inverse relationship between energy absorption and penetration
more the surface absorbs the less energy penetrates
39
Law of Conservation of Energy
energy is neither created nor destroyed- only converted from one form to another via refraction, reflection, transmitted, or absorbed
40
inverse-square law
amount of energy transferred relates to inverse square of the distance between objects
ex: lowering a lamp half the distance = 4 times the heating effect
distance matters
41
cosine law
the greater the angle between the beam of energy and the surface, the less amount of energy transfer
angle matters
energy will be refracted or reflected when the angle is not direct
42
principle of energy exchange
energy moves from higher to lower source
larger difference in energy = greater rate of exchange
longer application period = more energy transfer
43
informed consent
patients' right to receive information about their diagnosis and treatment options to grant consent to receive treatment
44
tort
civil legal action to redress injury caused by another person
45
negligence
omission or commission of an act, related to professional standards of practice
46
rehab plan of care steps
1) utilize a basic rehab model
2) address the problem (individualized)
3) clearly identify criteria for progression
47
modality selection
primarily alleviates pain
selected to meet specific, short-term goals
progress monitoring
48
what type of energy is the primary source of warm water immersion
thermal
49
which of the following principles states the greater the angle between the beam of energy and the surface, the less the amount of energy transger
cosine law
50
T or F informed consent is not necessary for each treatment administered in a single rehab session
False
51
primary team members
patient, AT, rehab student, physician, patients family, coach
52
secondary team members
friends, admin, teammates
53
AT role as rehab clinician
leader of the rehab team
communicate with all
record keeping
educate others
54
rehab clinicians demonstrate their professionalism by
-maintaining a professional appearance and demeanor
-continuing their education withing their profession
-contribute to the profession by being active in professional associations and organizations
-adhere to legal and ethical standards
55
principles of rehab acronym
ATC IS IT
56
what does ATC IS IT stand for
Avoid aggravation
Timing
Compliance
Individualization
Specific sequencing
Intensity
Total patient
57
elements of rehab
objectives and goals
examination and assessment
progression
58
rehab objectives
prevent deconditioning
rehab the injured part
59
rehab goals
objective and measurable
long term and short term
60
long term goal
final desired outcomes of the therapeutic exercise program
61
short term goal
reasonable and attainable yet should challenge the patient
62
program progression
programs should be designed to emphasize different types of goals as it progresses
63
pyramid of progression/return to play
performance
function
balance, coordination, agility
strength and endurance
flexibility and ROM
correct deviations and decrease pain
64
functional performance
injury based, weight room, overall muscle movements and ROM
65
activity specific performance
individuality, sport equipment, readjustment
66
prehab
used in advance of surgical procedures
-optimize patients mobility and strength so patient begins postoperative rehab
-quicker recovery
67
return to competition criteria
injured area has no pain, swelling, or atrophy, full ROM, flexibility, strength, and endurance
-patient can perform the sport or work skill
-physician has the final say
68
stages of grief
denial
anger
bargaining
depression
acceptance
69
when touching patients, precautions should include having other professionals present and having the door open
True
70
in the mnemonic ATC IS IT what does the S represent
specific sequencing
71
what are the elements of rehab
goals, assessment, progression
72
T or F goals are not required to be objective or measurable
false
73
therapeutic modalities can be utilized for what
reduce pain
decrease edema
74
what is prehab
a concept of maintaining/increasing function before surgery
75
T or F the AT has the final say on when a patient can return to activity
false
76
which of the following is the rehab clinicians roles in psychological recovery
establishing rapport with the patient
77
who is considered pediatric population
anyone from the time before birth to the completion of puberty, usually 21
78
when does growing stop
when the epiphyses close (18 for girls and 20 for boys)
79
Tanner stages of development
development stages for secondary sexual characteristics , a rate of height changes, and muscle development
80
Tanner stage 1
preadolescence
males: no pubic hair
females: no pubic hair, flat breasts
81
Tanner stage 2
early adolescence
males: darkening pubic hair, testes enlargment
females: sparse pubic hair, small, raised breasts
82
Tanner stage 3
middle adolescence
males: coarse and curling pubic hair, increased penis size
females: coarse and curling pubic hair, enlarged and raised breasts
83
Tanner stage 4
middle adolescence
males: continued penis growth
females: formation of areola and nipple
84
Tanner stage 5
end of adolescence
males and females: presence of adult gentalia
85
aka growth plate
physis
86
mnemonic for epiphyseal fractures
SALTER
87
class 1 SALTER (S)
slipped
separation from cartilage from bone without bone fracture
MOI: avulsion or Shearing
88
class 2 SALTER (A)
above physis
fracture extends through physis into metaphysis but not epiphysis
MOI: shearing or Avulsion
89
class 3 SALTER (L)
lower to the physis
fracture through the physis and epiphysis
MOI: intra-articular shearing forces
90
class 4 SALTER (T)
through the physis
intra-articular fracture from epiphysis through physis into metaphysis
MOI: impact or torsion
91
class 5 SALTER (ER)
erasure of physis or ER asap
compression fracture of epiphyseal plate
MOI: crushing force during lateral motion
92
apophysis
outgrowth of bone to which a tendon or ligament attaches
93
where does of Osgood-Schlatter disease occur
tibial tuberosity
94
recommendations for strength training pediatrics
1) teach proper technique and precautions
2) avoid powerlifting, bodybuilding, and max lifts
95
AAP recommendations on pediatric strength-training programs
1) undergo a medical evaluation by a MD prior to starting
2) kids with congenital cardiac disease should have a cardiology consultation prior
3) aerobic training coupled with resistance training
4) strength training include 10-15 minute warm-up and cool-down
5) proper hydration and nutrition
6) teach proper techniques with NO resistance, master first
7) address all muscle groups and through full ROM
8) any sign of injury or illness be evaluated prior to exercise
9) instructors should by a pediatric strength-training certification
10) proper technique and safety control
96
T/F strength gains occur in prepubescent children but not because of an increase in muscle size as in adults
true
97
how do children undergo strength gains
neural changes and improved neuromuscular recruitment
98
T/F children produce more sweat than adults
false
-children lose more fluid than electrolytes
99
rehab considerations for pediatrics
modalities
bone and articular cartilage maturity
muscle and tendon strength and age
neurological maturity
thermoregulatory precautions
-need both physiological and psychological aspect of rehab
100
T/F accuracy improves with repetitions
true
101
how are geriatrics at greater risk for sprains and strains
connective tissue becomes stiff and affects muscles, tendons, joints, and other structures (stress-strain curve)
102
stress
force applied to the muscle
103
strain
deformation of the muscle to the stress
104
T/F the muscular system declines about 50% from age 20 to 80
false, declines 40%
105
sarcopenia
reduction in both the size and number of muscle fiber
106
which muscle fiber declines faster
type II, decrease in strength and power = not recruited as often
107
osteopenia
mild moderate loss of bone density that places women at risk for advancing to osteoporosis
108
osteoporosis
loss of bone density
109
what leads to increase risk of total joint replacements
articular cartilage thins out and eventually calcification occurs and OA sets in
110
how does neurological factors affect geriatrics
influence balance, coordination, autonomic reflexes are less sensitive, and longer reaction time
-loss of sensesr
111
rehab considerations for geriatrics
-exercise is a positive influence on aging
--> decrease fall risk
-pay attention to heart rate, know target HR zones
112
therapeutic exercise considerations for geriatrics
-they move slower = require additional time
-difficulty hearing and slower comprehension
-vision issues = large fonts and diagrams
-decreases flexibility = avoid overstretching
-plan the rehab appropriately
-be aware of fall risks
-support the patient
-warm-up and cool-down
113
arthroplasty
joint replacement
114
indications for joint replacement
-last resort
-pain interferes with ADLs
-normal or routine functions are compromised
-deformity, weakness, and continued degeneration occurs
115
progression of pre-arthroplasty treatment
1) medications
2) rehab (prehab)
3) injections
4) surgical treatments (debridement, articular cartilage regeneration or replacemetn)
116
total hip arthroplasty (THA)
-start walking the day of or day after surgery
-begin exercise asap
-start with flexibility, then strength
-do not overstress the joint
117
total hip replacement considerations
-6 week to 3 months recovery
-hip flexion restricted to no more than 90
-hip adduction restricted to no more than 0
-bolster between legs while sleeping
-avoid medial rotation of the hip
-avoid combined motions of flexion, adduction, and lateral rotation (do not cross legs)
118
total knee arthroplasty (TKA)
-gait and exercise begin early
-assistive devices used in gait
-be on watch for embolism
119
total knee replacement considerations
-WB at tolerated post-op
-CPM machine post-op
-must achieve 0 degrees extension asap
-flexion goals: 110 for sedentary; 120-130 for active
120
total shoulder arthroplasty (TSA)
-sling worn for up to 6 weeks
-sling removed for exercise and showering
-flexibility, WB exercises, wait 1 month for strength, functional activities may not occur up to 6 months
121
total shoulder considerations
-arm sling 3-6 weeks
-early exercise: passive ROM
-WB and stabilization exercises
-reduced deltoids and subscapularis muscle stress early
-early active exercise for elbow, wrist, hand
122
girls usually begin puberty at a different time than boys, girls are usually _______ in development
2 years ahead of boys
123
T/F bones continue to grow until end of puberty
true
124
what is recommended that preadolescent children do in regards to weight lifting
permitted to lift low weights with high repetitions
125
sarcopenia is
decreased muscle mass secondary to aging
126
T/F older people have diminished balance, which places them at risk for falls
true
127
for a total shoulder arthroplasty how long should the patient be in a sling
6 weeks
128
factors affecting patient outcomes
-characteristics of injury
-specific situational factors
-interactions with HCP
-differences in personality
-individual cognitive appraisal
129
clinician considerations for psychological response to injury
-consider psychosocial barriers
-focus on treating the entire patient
-understand scope of practice and role on health care team
-recognize when a referral is necessary
130
Kubler-Ross 5-stage response
1) denial and isolation
2) anger
3) bargaining
4) depression
5) acceptance
-athletes may NOT experience all stages after injury
131
international classification of functioning (ICF)
incorporate disease, bodily function, activity, environmental and personal factors
132
Nagi's Disablement model
-disease
-impairment
-functional limitations
-disability
133
cognitive appraisal models
framework for understanding the psychological response to injury
-personal and situational factors affect how people appraise and respond to their injuries
134
primary appraisal
assessment of benefit, threat, harm, loss with respect to challenge
135
secondary appraisal
assessment of coping options available
136
cognitive appraisal vs stage models
-stages may be absent in cognitive appraisal models
-psychological-emotional response to injury does not occur in a structures order (ICF model)
-response may be affect by an understanding of the injury and psychosocial environment
137
maladaptive behaviors
not adapting appropriately or wrong way of adapting (use of drugs and alcohol)
138
clinician-patient interaction
-provide detail without overwhelming
-avoid talking down or being overly simplistic
-listen to and observe for a patients need
-monitor the patient throughout the rehab process
-personality and environmental factors may affect coping ability
139
emotional response to injury
-usually brief, could have positive effect on coping if controlled
-athletes must accept their injury
-complex and dynamic process
-self-perception may influence coping
140
athletic identity
their sport is their life
-negative emotions may occur from part of their life being taken away
141
athletic masculine identity
identity related to the team or sport, they are the "greatest player ever"
142
behavioral response to injury
-may affect adherence to place of care
-positive response include goal setting, imagery, positive self-talk, relaxation
143
social support affect on injury
-mediates stress-injury relationship
-helps them understand the injury
-clinicians tone and facial expressions may dictate the patients mood and outlook
-progressions through rehab results in enthusiasm and apprehension
144
assessment of fear
Tampa Scale for Kinesiophobia
145
how to maximize rehab compliance
adherence --> positive clinical outcomes
-athletes adherence to rehab is 40-91%
146
protection motivation theory
patient perceives health threat to be high, believes the treatment effective, and is able to carry out the treatment
147
personal investment theory
patient is self-motivated and has social support
148
cognitive appraisal models
patient has a supportive environment, is expected to adhere and believes the treatment is effective
149
short term goals
1-3 weeks
-established with the patient while developing plan of care
150
how to improve home exercise adherence
1) patient performs exercises before leaving the clinic
2) provide written instructions and illustrations
3) provide an exercise log to record performance
4) patient demonstrates exercises and beginning of subsequent session
151
strategies for successful rehab
-focus on short term goals
-minimize suffering
-differentiate between pain related to healing and pain from effort
-be sensitive for greater instruction, supervision, and encouragement in less active patients
152
barriers to successful rehab
-secondary gain: rewards for being ill/injured may outweigh rewards for returning to health
-substance use and abuse: affects recovery, referral for treatment
-social and environmental barriers: time, lack of access, team separation
-depression, anxiety, sleep disturbance
153
somatoform disorder
one or more physical complaints, without identifiable cause, lasting more than 6 months
1) provide care
2) establish rapport
3) avoid dismissing patients experience
154
stress reduction methods
biofeedback
muscle relaxation
thought stopping
deep breathing
imagery
155
indicators for somatization
-increased demand of your time
-requests for treatment requiring special attention
-anger when condition no longer needs treatment
-patients history inconsistent with physical exam
156
placebo effect
belief that medication or treatment will help without physiological benefits
-can be a positive influence on recovery
157
what is the established order of the Kubler-Ross five stage response to grief
denial and isolation
anger
bargaining
depression
acceptance
158
what should be avoided when interacting with a patient
being over simplistic
159
T/F patient adherence to rehab can range from 95-100%
false, 40-90%
160
what may be a barrier to successful rehab
depression
time demands
rewards of being injured
161
3 stages of the healing process
inflammatory (48-72 hrs)
proliferative (peak 1 week)
remodeling (last months to years)
162
macrotrauma
excessive force delivered at high velocity which results in ruptured tissue
-ex: ankle sprain, ACL tears
163
microtrauma
accumulation of stress over time = overuse injury
-may be asymptomatic, but can predispose the patient to traumatic injury
164
viscoelasticity
ability to elongate and return to normal length
165
mechanical creep
effects of force and time on viscoelastic tissue
166
overuse injury
constant force applied over time causing elongation of tissue
-accumulated elongation and decreased resistance to stress = more susceptible to injury
167
cells that rebuild the tissue
fibroblasts
168
process of inflammation
1) vasoconstriction, release of epinephrine and thromboxane A2 from platelets
2) platelets activate coagulation cascade = platelet plug (release of prostaglandin and thromboxane
3) secondary hemostasis occurs via activation of clotting cascade of plasma protein (results in production of fibrin)
4) influenced by cytokines = chemotaxis and vascular permeability
5) increased vascular permeability allows leukocytes to enter damaged tissue
--> proteins exert osmotic pressure and attract water = swelling
169
cardinal signs of injury
pain
loss of function
heat
redness
swelling
170
what influences inflammation
cytokines (chemotaxis and vascular permeability)
171
T/F vascular permeability decreases swelling
false, increases swelling
172
what causes swelling to occur
leukocytes and plasma proteins move outside of the capillaries, altering osmotic pressure = brings water to the area
-influenced by cytokines
173
what removes swelling
lymphatic sysyem
174
plasma protein cascade
1) clotting cascade converts fibrinogen to fibrin
-mesh like web to temp repair damaged tissues
2) factors XII (first protein in clotting cascade), activates kinin cascade
-prekallikrein to kallikrein
-kininogen to bradykinin
3) bradykinin interacts with prostaglandins causing pain
4) complement cascade breaks down dead cells, attracts leukocytes (chemotaxis), increased capillary membrance permeability, phagocytosis via opsoniation
-mast cell degranulation
175
clotting cascade
-vasoconstriction
-fibrinogen to fibrin
-fibrin force mesh like platelet plug
-factor XII activates kinin cascade
176
kinin cascade
-prekallikrein to kallikrein
-kininogen to bradykinin
-bradykinin increases capillary membrance permeability and interacts with prostaglandins = pain
177
complement cascade
-lysis of dead cells
-chemical attraction of leukocytes (chemotaxis)
-increased capillary membrance permeability
-phagocytosis via opsonization
-stimulates mast cell degranulation
178
what coats bacteria or damaged cells to facilitate inflammatory cell binding and ingestion
opsonin
179
purpose of clotting cascade
prevent loss of RBCs
180
purpose of kinin cascade
increase capillary membrance permeability
181
purpose of complement cascade
facilitate all aspects of acute inflammatory response
182
clotting cascade relation to signs of inflammation
no direct relationship
183
kinin cascade relation to signs of inflammation
pain and swelling
184
complement cascade relation to signs of inflammation
increases all signs of inflammation
185
histamine
purpose: vasodilation
relation to signs of inflammation: heat and redness
186
neutrophil chemotactic factor
purpose: attract neutrophils to phagocytize necrotic tissue
relation to signs of inflammation: indirect swelling because membrance permeability is required for neutrophil emigration
187
serotonin
purpose: increase capillary membrane permeability
relation to signs of inflammation: swelling
188
heparin
purpose: prevent occlusion of capillary blood flow
relation to signs of inflammation: no direct relationship
189
prostaglandin E2
purpose: increase capillary membrane permeability
relation to signs of inflammation: pain and swelling
190
leukotrienes
purpose: attract neutrophils to phagocytize necrotic tissue
relation to signs of inflammation: indirect swelling
191
what arrives at the injury site first, peaks within 24 hours post-injury
neutrophils
-acts as "bug spray" attacks bacteria and tissue
-engulf reactive oxygen species (ROS)
192
macrophages
-phagocytic
-influenced by cytokines
-contribute to cell recruitment and proliferation, promotion of angiogenesis, matrix production/remodeling
193
PRICE
protection
rest
ice
compresion
elevation
194
POLICE
protection
optimal loading
ice
compression
elevation
195
PEACE & LOVE
protection
elevation
avoid NSAIDs
compression
education
&
load
optimism
vascularization
exercise
196
T/F macrophages contribute to matrix production
true
197
what does O in the POLICE stand for
optimal loading
198
proliferation phase
-removal of debris and temporary repair of tissue
-revascularization, regeneration, and/or repair
-peaks around day 6 and up to 2 weeks
-fibroblasts are activated, proliferate, and produce ECM (produce type III collagen)
-plasma fibrin and fibronectin deposited at site of the injury to assist with wound healing
199
what is proliferation influenced by
cytokines
200
extent of repaid depends on
individuals health
blood supply to the tissue
resident cell type and activity
degree of injury
-therapeutic exercise may stimulate or halt repair
201
skeletal tissue healing
after injury, hematoma forms between myofibers and proinflammatory cytokines increase permeability
-macrophages phagocytize damaged tissue
202
remodeling and maturation phase
-activated fibroblasts produce type I collagen
-influenced by cytokines and modulation of inflammation
-can last up to 2 years
-therapeutic exercises may stimulate or halt repair
203
tendon healing
-complicated by lack of blood supply
-inflammatory lasts 3-7 days
proliferative phase last for 3 weeks
-tenoycyte secrete type III collagen and tranistions to type I collage around 5-8 weeks
-tenocyte releases vascular endothelial growth factor to promote healing
-endotendon attachment site for tenocytes, vasculature, and lymphatics
-epitenon surrounds fibers and forms fascicles
-
204
ligament healing
-once damaged tissue is removed, neovascularization occurs
-results in framework of dense type I collagen and ECM
-extra-articular ligaments heal better than intra-articular ligaments
205
bone healing
-after fracture, osteocytes trigger ECM destruction (2-5 days)
-hematoma forms
-site attracts inflammatoru cells and mesenchymal stem cells
-platelets release cytokines
-forms a callus (type III collagen
-type I collagen and mineralization occur, remodel into lamellar bone (repair can take 2-12 months)
-organized in pillars or osteons
-comprised of type I collage, hydroxyapatite mineral, and proteoglycan
-osteoblasts synthesize ECM and release calcium and phosphate
-osteocytes develop intercellular connection network
206
cartilage healing
-articular cartilage is avascular, aneural, and alymphatic
-very limited repair potential
-repaired through fibrous scar deposition
207
secondary hypoxic injury
causes cell death due to decrease in oxygen supply to the area
-first seen in the mitochondria within 30 minutes of primary trauma
208
edema
build-up of excessive fluid and protein in the interstitial space resulting from the imbalance between pressures inside and outside the cell membrane
-disrupts lymphatic flow
209
what is the primary goal during early injury management
decrease formation of edema and remove swelling from the injury site
-ice reduced edema formation
210
how is edema removed
increasing venous and lymphatic return
gravity
blood circulation
compression
211
Starling's Law
described the movement of fluids across the capillary membrane that results in the formation or removal of swelling
-the vascular hydrostatic pressure and the interstitial fluid colloid osmotic pressure forces the contents from the capillary to the tissues
-the plasma colloid pressure moves fluids from the tissues into the capillaries
-the limb's hydrostatic pressure is altered by changes in the position of the limb
-think of a pressure washer clearing the gutters of the leaves and going into a drain
212
what is the best way to describe Starling's law
movement of fluids across the capillary membrane during swelling
213
muscle spasm
involuntary contraction of muscle fibers
-caused by direct trauma, decreased oxygen, or neurological dysfunction
-stimulates mechanical and chemical pain receptors
214
muscle atrophy and weakness
-disuse atrophy and denervation atrophy
-edema and inflammation stimulate Golgi tendon organs = increase rate of atrophy
215
chronic inflammation
-caused by low-intensity irritants
-can develop chronic without first going through acute stages
-strong predictor of future disability
216
the acute inflammatory phase last how long in tendons
3-7 days
217
T/F osteoblasts release chloring and phosphate
false, calcium and phosphate
218
T/F cartilage has excellent healing abilities
false, poor healing abilities
219
T/F secondary hypoxic injury causes cell death due to a decrease in oxygen supply to the area
true
220
what is pain
unpleasant physical and emotional experience
221
psychogenic pain
pain but no structural injury
222
clinician goal with pain
reduce pain so therapeutic exercise can be performed and function restored
223
nociception
neural processes of encoding and processing noxious stimuli
-neurophysiological process interpreted as pain
224
cerebral cortex and pain
alters a persons perception and reaction to pain
225
T/F pain perception varies from person to person and from day to day
true
226
battlefield conditions
an athlete may be so focused on the competition when an injury occurs, it magnitude may not be immediately recognized
227
sensory receptors classifications
special
visceral
deep
superficial
deep
228
superficial sensory receptors
mechanoreceptors
thermoreceptors
nociceptors
229
deep sensory receptors
proprioceptors
nociceptors
230
mechanoreceptors
pressure and touch
skin stretch and pressure
231
thermoreceptors
temperature and temp changes
232
nociceptors
pain
233
proprioceptors
changes in muscle length and muscle spindle tension
change in joint position
vibration
joint end range, possible heat
234
somatosensory system
receives input from receptors in periphery and sends it to higher centers in the brain for interpretation
235
afferent pathway
sensory nerves transmit pain signal to higher centers
-classified by structure and function
-conduction velocity increases with myelination
236
thalamus
relay center of second order neurons for pleasant and noxious sensory input
237
neocortical tract pain
-acute pain-rapid 3-neuron sequence
-nociceptor -> spinal cord via sensory nerve (1st order neuron) -> second order afferent neruron (T cell) crosses spinal cord -> thalamus -> third order neuron -> sensory cortex of brain
-first pain
238
first pain
localized, discriminative
-initial experience of pain
239
paleocortical tract pain (Melzack's)
-nociceptors -> C fibers -> T cell -> supraspinal brain areas
-second pain
240
second pain
affective-motivational
-emotional experience of pain
241
A-alpha fiber
large diameter
thick myelin
fastest
242
A-beta
large diamtere
thick myelin
fast
touch and vibration
243
A-delta
large diameter
thin myelin
slow
PAIN
touch, pressure, temp
244
C fiber
small diameter
no myelin
slowest
PAIN
245
descending pathways
-excitatory or inhibitory affect after cortex received inpit
-either doesnt do anything or release endorphins
246
synaptic transmission
-facilitory (excitatory): depolarizes postsynpatic nerve; Ach and glutamate
-inhibitory: blocks depolarization, glycine and GABA
-beta endorphins: inhibit pain impulses
247
persistent pain
beyond what is expected
-physiological and/or psychological
248
chronic pain
3-6 months
-more psychological
249
sources of chronic pain
up regulation of salient nociceptors (constantly activated)
-change in chemical environment around free nerve endings
-increased sensitivity of second order afferent neurons
250
evaluation of pain
-rule of medical conditions
-assess structural or biomechanical sources
-immediate pain vs underlying causes
251
rest-reinjury cycle
misconception that absence of pain symbolizes complete tissue healing
252
complex regional pain syndrome type I
musculoskeletal or soft-tissue injury
253
complex regional pain syndrome type II
nerve injury
254
myofascial pain
characterized by pain emanating from muscles and connective soft tissues
-causes: injury/accident, poor posture, faulty movement mechanics, stress
255
T/F pain is only considered an unpleasant physical experience
false, also psychological
256
ruffini endings are considered which type of sensory receptors
mechanoreceptors and proprioceptors
257
T/F a nociceptor sends information the spinal cord via motor neurons
false, via sensory neurons
258
what fiber is myelinated afferent neuron that transmits pain signals
A-delta fibers
259
what would happen if glycine is released in response to a descending pain signal
synapses would depolarize and results in no painful sensation
260
what does PQRST stand for
provocation
quality or characteristics
referral or radiation
severity
timing
261
referred pain
pain in a separate location from the pathology
-treat the injury, not just the pain site
262
patient-reported outcome (PROs)
track change over time, determine treatment effectivness, and quantify patient perspective
263
perception of pain influenced by
previous pain experience
family and cultural background
specific situation
264
pattern theory
pain occurred when sensory input exceeded a threshold (pattern of action potentials)s
265
specificity theory
pain perceived when peripheral receptors were stimulated (direct connection to the brain resulted in pain)
266
neuromatrix theory of pain
multidimensional experience from neurosignature patterns of nerve impulses (brains control over cognitive-evaluative, motivational-affective, and sensory-discriminatory systems)
267
ascending mechanism of gate control theory
-increase non-nociceptive stimulu from periphery to spinal cord for pain relief (rubbing your arm after getting hit)
-A-beta fibers decrease input of pain signal
268
descending pain modulation of gate control theory
-nociceptive pathway and stimulu are transmitting to higher centers
-descending mechanisms initiated by endogenous opiates and central biasing
269
what controls the release of beta-endorphins
hypothalamus
270
what inhibits pain perception
beta-endorphins
271
another opiate triggered by descending mechanism
enkephalin
272
central biasing
synapses with spinal enkaphalin interneurons closes the gate
-serotonin inhibits the second-order neuron
-norepinephrine released at the spinal level, inhibits pain transmission
273
peripheral pain modulation
desensitive peripheral nociceptors
-medication can act at pain site
-subsensory (TENS)
274
T/F a challenged immune system can increase pain sensitivity
true
275
treating persistent pain
source of dysfunction may be distant from location of pain
-referred pain patterns
276
referred pain
pain originating from inflamed structures producing pain elsewhere in the body
-left shoulder or left side pain could mean visceral organ damage
277
myofascial pain syndrome
no single treatment approach most effective
-massage, graston
-TENS
-goal is to break the pain cycle
278
complex regional pain syndrome management
managed with sympathetic blocks and medication
279
chronic pain treatment
-chronic pain is result of altered neural function
-continued palliative treatment may not be beneficial
280
T/F patient reported outcome may be used to track change over time, but cannot be used to quantify patient perspective
false
281
what may influence pain perception
previous pain experience
family background
specific situation
282
how would you "close the gate" according to the ascending mechanism of the gate control theory
increase non painful stimuli to the area
283
form of a subsensory level peripheral pain control modulation
electrical stimulation
284
T/F a challenged immune system can decrease pain sensitivity
false, increases
285
T/F the rest-reinjury cycle occurs when the absence of pain is misinterpreted as indication of tissue healing
true
286
a therapeutic modality is
a device or apparatus having curative powers
287
T/F the primary selection of any health intervention should be purposeful and goal-orientated
true
288
a civil legal action brought by a person injured while being treated be an ATC would be
tort
289
correct descriptions of evidence based practice
-it acknowledges ongoing changes in clinical practices
-it highlights the important of being well educated and remaining correct
-it is the integration of best research evidence with clinical expertise
290
T/F thermal energy is used to increase or decrease tissue temperature
true
291
inverse relationship between energy absorption and penetration
law of grotthus-draper
292
T/F during application of a therapeutic modality, energy generally moves from a lower to a higher state
false
293
components of Nagi's model of injury
disability
disease
impairment
294
T/F active individuals and athletes typically experience all 5 psychological stages during recovery from a musculoskeletal injury
false
295
this model suggests that personal and situational factors affect a persons response to injury
cognitive appraisal model
296
what is a response regarding a patient or athletes emotional response to injury
it is complex and dynamic process
297
T/F adherence to rehab program positively correlates with self-motivation
true
298
what patient outcome instrument can be used to measure a patients fear level
Tampa scale
299
T/F a long term goal of a therapeutic exercise program is its final desired outcome
true
300
progressing a patient is based on
whether or not the patient achieved the objectives of the exercise
301
the Tanner staging system is based upon a method of
categorizing sexual stages of development
