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KNAT 522 > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

3 components of neuromuscular control

A

volitional contractions
reflex reactions
complex functional movements

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2
Q

definition of AMI

A

compromised ability to contract a muscle due to injury

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3
Q

what affects volitional muscle contractions (what can cause AMI)

A

swelling
pain
altered mechanoreceptor input

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4
Q

how does swelling impact muscle contractions

A

-may stimulate stretch receptors and trigger reflex inhibition

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5
Q

how does pain impact muscle contractions

A

-contributes to deficits in neuromuscular control
-painful exercise may slow recovery

pain -> inhibits muscle groups -> altered motor control -> change in movement pattern -> delayed recovery/increased risk of re-injury

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6
Q

how does altered input impact muscle contractions

A

-altered patterns may affect function
-ex: ankle: decreased position and balance sense, postural control; treatment: progressive balance/coordination exercises

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7
Q

what is used to address AMI after injury or surgery

A

neuromuscular electrical stimulation (NMES)

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8
Q

how does NMES work against AMI

A

developed to increase muscle strength

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9
Q

a nerve’s response to electrical stimulation is based on 3 factors

A

1) diameter of the nerve
2) depth of the nerve in relation to the electrode
3) phase duration of the current

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10
Q

which nerves are stimulated first

A

sensory nerves

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11
Q

which nerves are depolarized first

A

large-diameter nerves

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12
Q

exogenous contration

A

-NMES elicited
-entire motor unit stimulated to fatigue
-synchronous firing
-fatigues quickly (PC energy system)

-large diameter, fast-twitch fibers recruited first (low capacitance), slow twitch recruited once stimulation is increased
-GTO is excited

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13
Q

endogenous contraction

A

-physiological
-slow twitch fiber recruitment first
-asynchronous firing
-slow to fatigue

-slow twitch fibers excited first, fast-twitch are recruited if enough force is given (preserves energy)
-GTO causes inhibition = relax muscles from strong contraction

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14
Q

duty cycle for NMES

A

1:5 on to off time (10 seconds on, 50 seconds off)
-progress to 10:30

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15
Q

phase duration of NMES

A

250-300 us

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16
Q

pulse rate of NMES

A

35-50 pps

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17
Q

amplitude of NMES

A

produce strong, yet tolerable contractions

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18
Q

types of neuromuscular stimulation

A

russian
PENS

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19
Q

russian stimulation

A

-used for muscle reeducation
-patient contracts with the current, then relaxes
-preset parameters
-can produce a strong tetanus contraction

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20
Q

PENS

A

-patterned electrical neuromuscular stimulation: timed stimulation based on typical firing patterns (walking, running, jumping, etc)
-asymmetrical low-voltage pulsed current
-50 Hz pulse rate
-70 us phase duration

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21
Q

electrode placement of russian

A

bipolar: proximal and distal ends of the muscle

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22
Q

treatment duration of russian

A

10 cycles or until they are fatigued

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23
Q

ramp time of russian

A

2 seconds; time to reach full current

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24
Q

treatment of AMI with inhibited muscle

A

-apply NMES
-recruit motor neurons being reflexively inhibited

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25
Q

treatment of AMI with disinhibited muscle

A

-apply disinhibitory TENS (with therapeutic exercise) and cryotherapy
-decrease relative inhibitory activity and cause reflex activation of inhibited motor neuron

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26
Q

what causes denervation

A

trauma or disease

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27
Q

goal of NMES with denervation

A

overcome capacitance of the muscle

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28
Q

biofeedback

A

-does not produce a muscle contraction, visual or audio representation of a muscle contraction
-brings awareness of what muscles are being recruited with different movements

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29
Q

how many leads are required for EMG

A

2 active leads and a ground lead -> signal processed -> feedback

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30
Q

goal of EMG biofeedback

A

regain ability to contract the muscle

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31
Q

goal of NMES

A

restart motor efferent-proprioceptive feedback loop, induce contraction
-reconnect the neural loop from muscle to the brain

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32
Q

reflex responses

A

-progressively increase challenge to reflex responses to reduce rate of reinjury
-ex: balance on a training disk or wobble boards
-progress from reflex training to sport-specific

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33
Q

relaxation

A

-thought stopping, visual imagery, breathing exercises, isolated muscle contraction/relaxation
-may break the cycle of stress, pain, spasm

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34
Q

T/F the use of a mirror to provide visual feedback may assist with restoring neuromuscular control

A

true

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35
Q

example of a reflex reaction

A

quick movement of the foot after stepping on a lego

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36
Q

put in order how pain may be cause an increased risk of re-injury

A

pain -> inhibits muscle group -> altered motor control -> change in movement pattern -> increased risk of re-injury

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37
Q

T/F large diameter nerves correspond to fast-twitch fibers and fatigue quickly

A

true

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38
Q

an athlete who undergoes an arthroscopic partial menisectomy experiences a dramatic decrease in the ability to perform a quad set and straight leg raise the day after surgery, what has occurred

A

athlete is demostrating impaired control over volitional, isolated, quad muscle contraction

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39
Q

hip pain and arthritis may result in inhibition of what muscle

A

gluteus maximus

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40
Q

the restoration of neuromuscular control through the use of EMG biofeedback occurs

A

by restoring the loop between efferent output and afferent input into the CNS

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41
Q

example of AMI

A

inability to perform shoulder external rotation due to pain

inability to extend the knee after an ACL tear

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42
Q

contraindication to NMES

A

unstable fracture

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43
Q

T/F NMES is a efficient modality to increase muscle strength

A

true

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44
Q

what is ultrasound

A

deep-penetrating agent that produces changes in tissue through thermal and nonthermal (mechanical) mechanisms
-uses sound waves

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45
Q

uses of ultrasound

A

-diagnostic imaging
-*therapeutic deep tissue healing
-tissue destruction (break up kidney stones)

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46
Q

what depth is ultrasound used for in therapeutic deep tissue healing

A

1-3 W/cm^2

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47
Q

which MHz penetrates deeper in ultrasound

A

1 MHz penetrates deeper than 3 MHz

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48
Q

how are sound waves produced in ultrasound therapy

A

-alternating current travels through the coaxial cable into the transducer
-the current passes through the piezoelectric crystal which causes it to expand and contract which produces the sound waves

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49
Q

reverse piezoelectric effect

A

converts electrical energy into mechanical energy in the production of sound waves

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50
Q

what shape are ultrasound waves

A

sinusoidal (curvy up and down)

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51
Q

longitudinal waves

A

-molecule displacement occurs parallel to the direction of the sound
-travel through bone and soft tissue and liquid

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52
Q

transverse (shear) waves

A

molecule displacement occurs in a perpendicular to the direction of the energy
-created when a transverse waves strikes a bone
-cannot pass through fluids

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53
Q

Fresnel zone

A

-aka near field
-portion of the ultrasound beam used for therapeutic purposes

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54
Q

effective radiating area (ERA)

A

-proportion of the transducer’s surface area that produces ultrasonic energy (cm^2)

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55
Q

large ERAs

A

-produce collimated, focused beam
-used for treating a localized area such as a trigger point

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56
Q

smaller ERAs

A

-yield a divergent beam
-used for when treating a larger area like a muscle strain

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57
Q

frequency

A

-MHz
-how deep the waves penetrate

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58
Q

which frequency (MHz) ultrasound beam diverges more

A

1 MHz diverges more than 3 MHz

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59
Q

how deep does 1 MHz penetrate

A

about 5 cm

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60
Q

how deep does 3 MHz penetrate

A

2.5-3 cm

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61
Q

how to calculate treatment time

A

desired temp/heating rate

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62
Q

which frequency (MHz) has a longer treatment duration

A

1 MHz has a longer treatment duration that 3 MHz

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63
Q

spatial average intensity (SAI)

A

-amount of energy passing through the sound head’s ERA (W/cm^2)

total Watts (W)/ERA (cm^2)

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64
Q

100% continuous duty cycle

A

-always on and produces thermal effects
-used for tissues 5 cm or deepers

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65
Q

pulsed output duty cycle

A

-causes nonthermal (mechanical) effects
-decreases SAI, reduce thermal effects, increases proportion of nonthermal effects

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66
Q

thermal effects

A

-increase blood flow
-increase viscoelasticity
-increase inflammation
-increase muscle temp

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67
Q

how to calculate duty cycle

A

pulse length (on time)/ (pulse length (on) + pulse interval (on + off) *100

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68
Q

spatial average temporal peak intensity (SATP)

A

-avg intensity during the on time of the pulse
-total amount of energy delivered to the body during the treatment

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69
Q

spatial average temporal average intensity (SATA)

A

-measures the power of the ultrasonic energy delivered to the tissues over a given time (total watts/time)

output * duty cycle

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70
Q

beam nonuniformity ration (BNR)

A

-describes the variation between the peaks, the spatial intensity, and the valley
-low BNR increases risks of hot spots
-high BNR greater than 5:1
-low BNR less than 4:1

spatial peak intensity/spatial avg intensity

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71
Q

half-layer value

A

-depth where 50% of the ultrasonic energy has been absorbed by the tissues

72
Q

attenuation

A

intensity of ultrasonic energy decreases as the distance it travels increases
-occurs through the scattering and absorption of the waves within the tissues

73
Q

what happens to the ultrasound beam when it interacts with different tissue layers

A

some of the energy is reflected or refracted
-amount of reflection depends on the degree of change in density
-interface between soft tissue and bone is highly reflective

74
Q

T/F ultrasound energy is affected by adipose tissues

A

false; the waves can easily pass through it

75
Q

nonthermal effects

A

changes within the tissue resulting from the mechanical effect of ultrasonic energy

76
Q

thermal effects

A

changes within the tissue as a direct result of ultrasound’s elevation of the tissue temp

77
Q

what produces nonthermal effects that stimulate the healing process

A

acoustical streaming
cavitation
microstreaming

78
Q

how does ultrasound effect the injury response process

A

-effects depend upon
–mode of application (continuous or pulsed)
–frequency of the sound
–size of treatment area
–vascularity and density of target tissues
–deep thermal effects

79
Q

ultrasound effects on cellular response

A

-acoustical streaming and cavitation increases cell membrane permeability, changing the diffusion rate

-increased histamine release
-increased intracellular calcium
-mast cell degranulation
-increased rate of protein synthesis

thermal effects:
-increased cell metabolism
-accelerated rate of inflammation

80
Q

ultrasound effects on inflammation

A

-changes in cell membrane permeability -> degranulation and release of growth factors and platelets -> fibroblasts proliferation
-creates new cells quicker to speed up the healing process

81
Q

ultrasound effects on blood and fluid dynamics

A

continuous ultrasound increases blood flow, dilation of blood vessels, histamine release

82
Q

ultrasound effects on nerve conduction and pain

A

-nerve conduction velocity increased from thermal effects
–increase pain threshold

-reduces activity of chemosensitve pain receptors
–increased blood flow
–increased capillary permeability

83
Q

ultrasound effects on muscle spasm

A

-reduced mechanical and chemical triggers that continue the pain-spasm-pain cycle
–relaxation of muscle tension
–increase blood flow
–increase O2 delivery
–aiding in elongation of muscle fibers

84
Q

ultrasound effects on tissue elasticity

A

-heats collagen-rich tissues, especially tendon, ligament, fascia, and scar tissue
-used for elongation of tissue
-have 3 minutes to stretch post-treatment

85
Q

ultrasound effects on muscle and tendon healing

A

-1 MHz continuous output enhances release of preformed fibroblasts
-3 MHz increases cells ability to synthesize and secrete building blocks of fibroblasts

86
Q

ultrasound effects on wound healing

A

-increase breaking strength of incisional wounds
-ultrasound used at 1 W/cm^2 may have an inhibitory effect on wound healing because necrotic tissue is unable to dissipate heat

87
Q

ultrasound effects on fracture healing

A

low-intensity pulses ultrasouns applied in 1 20-min session per day has an improved healing rate for acute and nonunion fractures
-applied early in the healing process

88
Q

phonophoresis

A

-assist in the diffusion of medication through the skin
-pushes meds deeper into the tissue
-cavitation is believed to cause small openings to increase pore size
-mix meds into the ultrasound gel

89
Q

contraindications of ultrasound

A

-DVT
-areas of sensory deficit
-ischemic areas
-impaired circulations

-cancerous tumors
-active fractures
-metal or bony implants
-pregnancy

-joint replacements
-over fluid filled cavities
-over implanted pacemakers
-caution over vertebral column, nerve roots, and large nerve plexus

90
Q

capacitance technique of diathermy

A

-patient places in an electric field, rapid rotation of dipoles results in mechanical friction and head production (heats subcutaneous fat)

91
Q

inductance technique of diathermy

A

electric current through coiled wire creates electric current in tissue, heats the muscle

92
Q

what temp does pulse diathermy heat

A

deep tissue 3-4 degrees C

93
Q

contraindications/precautions of diathermy

A

-remove all metal from the patient
-avoid use near abdomen/back of pregnant women
-do not use in presence of infection, acute inflammation, open wounds, malignant tumors, large joint effusion

94
Q

what currents does diathermy produce

A

eddy currents

95
Q

pulse diathermy

A

-low frequency (<600 pps)
-short phase duration (65 us)
-nonthermal
-used for treatment of nonunion fractures, osteoarthritis, wound healing

96
Q

you want to heat a deep tendon strain that is about 4.5 cm deep, what parameters would you use

A

1 MHz

97
Q

what is the spatial average intensity if the power is 10 W and the ERA is 5 cm^2

A

10/5 = 2 W/cm^2

98
Q

T/F longer treatment duration with ultrasound are needed for people with more adipose tissue

A

false

99
Q

what causes nonthermal effects of ultrasound

A

acoustical streaming
cavitation
microstreaming

100
Q

T/F pulsed diathermy may be used to heat deep tissue 3-4 degrees C

A

true

101
Q

what is true about cavitation

A

-cavitation is associated with nonthermal effects of ultrasound
-cavitation involves the expansion and contraction of gas bubbles
-unstable cavitation refers to the collapse of these bubbles and can cause tissue damage
-stable cavitation facilitates fluid movement and membrane transport

102
Q

definition of effective radiating area ERA

A

proportion of the transducer’s surface area that produces ultrasonic energy

103
Q

definition of frequency

A

number of events which occur in 1 second

104
Q

definition of power

A

unit of energy of ultrasound

105
Q

definition of intensity

A

strength of the sound wave at a given location

106
Q

definition of half-layer value

A

depth where 50% of the ultrasound energy has been absorbed

107
Q

definition of duty cycle of ultrasound

A

percentage of time there is energy output during the ultrasound application

108
Q

you have a basketball player come to you complaining of patellar tendon pain which started 2 days ago, you decide to perform ultrasound; what are the parameters

A

-output frequency: 3 MHz
-duty cycle: 20% (because it is acute injury)
-output intensity: 0.5 W/cm^2
-treatment duration: 4 min

109
Q

T/F within a set time, a larger treatment area can be heated with diathermy than with ultrasound

A

true

110
Q

ultrasound pass through soft tissue as what wave. when the ultrasound contacts bone the beam is transformed into what wave

A

longitudinal wave through soft tissue

transverse wave once it hits bone

111
Q

true statements regarding phonophoresis

A

-similar to iontophoresis in that it drives meds through the skin
-it is noninvasive and spares the patient the fear of injections
-one must mix the active med with a good conducting gel

112
Q

clinical use of therapeutic ultrasound

A

heat connective tissue before joint mob to increase ROM

113
Q

precautions of ultrasound

A

-Changes in bowel or bladder habits
-A skin lesion lasting longer than 6 weeks
-Unusual bleeding or discharge
-Thickening or lump in the tissue
-Indigestion or difficulty swallowing
-Obvious changes in a mole or wart
-Nagging cough/hoarsness

114
Q

nonmusculoskeletal relate symptoms that warrant a referral before ulrasound

A

-proximal or bilateral muscle weakness
-bilateral change in deep tendon reflex
-enlarged lymph nodes
-increased pain at night, night pain, sweating
-constant, intense pain

115
Q

when to use 100% duty cycle

A

-continuous output for thermal effects

116
Q

when to use a low duty cycle for ultrasound

A

-treat acute injured
-or when nonthermal effects are desired

117
Q

ultrasound technque

A

-slowly move sound head
-area should be only 2-3 times the ERA/transducer’s head
-maintain contact with transducer and the skin
-continuous moving to prevent burns
-perform treatments within 5-10 minutes

118
Q

direct coupling

A

-transducer is applied directly to the skin with the use of an ultrasound gel

119
Q

pad (bladder) ultrasound method

A

-coat the gel pad/bladder both sides with ultrasound gel
-used for curved or irregular shaped areas in order to maintain full contact with the skin

120
Q

immersion ultrasound technique

A

-body part is immersed in a tub of sterile or distilled water
-wipe away air bubbles
-place transducer in water about 1/2 inch from the body part

121
Q

use of ultrasound and electrical stimulation at the same time

A

-ultrasound head serves as an electrode for stim
-slowly move the transducer to produce increased temp
-used for trigger points and superficial painful areas
-results in a muscle spasm or involuntary contraction

122
Q

goal of diathermy

A

heat deeper tissue
-larger areas can be treated

123
Q

indications for diathermy

A

-similar to ultrasound
-assist in restoring motion, functional gains, and return to play

124
Q

contraindications for diathermy

A

-open wounds
-patients with internal fixation or arthroplasty

125
Q

prep and treatment using diathermy

A

-patient is comfy
-remove jewelry and piercings
-skin is exposed and dry
-towel placed between skin and diathermy drum
-treatment time 15-20 minutes
-expect a warm sensation

126
Q

low-intensity pulsed ultrasound (LIPUS) and pulsed electromagnetic field (PEMF)

A

-management of fractures
-no known adverse responses or contraindications
-treatment time based on manufacturer
-can be self administered

127
Q

what does LASER stand for

A

light amplification of stimulated emission of radiation

128
Q

low level laser therapy tissue temp remains below

A

36.5 degrees C

129
Q

FDA approved used of LLLT

A

-minor chronic neck and shoulder pain (630 nm)
-carpal tunnerl (830 nm)

130
Q

how is a laser produced

A

energy applied to an atom -> atom is excited -> atom returns to ground state -> energy released as a photon

131
Q

amplification

A

photon generation leads to an increased amount of light energy

132
Q

properties of laser light

A

monochromic
coherent
collimated

133
Q

monochromic

A

one color or wavelength specific to the energy level of the photon

134
Q

coherent

A

all waves of light energy at the same length and travelling in a similar phase relationship

135
Q

collimated

A

beam remains parallel with distance

136
Q

what are examples of type 1 lasers

A

laser printers
CD players

137
Q

what are examples of type 2 lasers

A

bar code scanners
-lasers that do not exceed AEL of 1 mW

138
Q

what are examples of type 3a lasers

A

laser pointers
-AEL of less than 5 mW, medium power

139
Q

what are examples of type 3b lasers

A

LLLT
-AEL between 5 and 500 mW

140
Q

what are examples of type 4 lasers

A

hazard to eyes and skin
-AEL above 500 mW

141
Q

helium-neon lasers

A

-6-10 mm depth of penetration
-indicated for superficial wound care and dermatological problems

142
Q

indium-gallium-aluminum-phosphide laser

A

-semiconductor, less coherence than gas lasers
-indicated for superficial wound care and dermatological problems

143
Q

gallium-arsenide laser

A

-30-50 mm depth penetration
-indicated for tendinopathies, osteroarthritis

144
Q

gallium-aluminum-arsenide laser

A

-increased power output = shorter treatment times
-indicated for deeper ligament and tendon injuries

145
Q

combination probes

A

LED and laser

146
Q

power density of LLLT

A

-irradiance or intensity of the beam
-how much power is going through the beam diameter

intensity = power/beam diameter

147
Q

average power of LLLT

A

-continuous or pulse-train (burst) frequency mode

avg power = peak output power * duty cycle

148
Q

treatment duration of LLLT

A

-dependent on total energy
-potential for skin burns if power is doubled

149
Q

energy density or dosage of LLLT

A

-amount of energy applied per unit of area
-measured in joules

150
Q

treatment frequencies of LLLT

A

-3-4/wk with moderate dose may be more effective than high dose fewer times a week
-cumulative effect: small doses over time

151
Q

how does LLLT effect ATP production

A

-chromphores or photoacceptors (in the mitochondria) absorb photons
-> increase oxidative metabolism

-increased ATP production leads to synthesis of new cells responsible for repairing damaged tissue

152
Q

how does LLLT effect nitric oxide release

A

-laser may assist in the release of NO (photodissociation)
-allows O2 to bind and produce ATP

153
Q

how does LLLT effect reactive oxygen species (ROS)

A

-metabolic by-product of oxygen use in mitochondria
-laser may be lower levels of ROS

154
Q

T/F LLLT may promote normal cellular function rather than changing cell function

A

true

155
Q

an 830 nm laser would fall into which wave category

A

IR waves

156
Q

if you want to treat shoulder pain, which wave length would you select

A

630 nm

157
Q

T/F gallium-arsenide lasers can be used on deep ligaments

A

false

158
Q

what is a physiological effect of LLLT

A

increased oxidative capacity

159
Q

what is a photon

A

particle of light

160
Q

what classifications of laser can cause harm to skin and eyes therefore must wear goggles during treatment

A

3b and above

161
Q

how does chromoreceptors/photoacceptors increase healing time

A

absorb photons -> increase oxifative metabolism -> provide energy to the cell -> increases the healing time

162
Q

what are reactive oxygen species (ROS)

A

waste products
-needs to be eliminated in order to increase number of healthy cells

163
Q

goal of LLLT

A

promote healing and reduce pain

164
Q

tips for effective application of LLLT

A

-perpendicular, firm contact (unless open wound)
-gradually increase dosage
-inquire about patient’s sensations and post-treatment changes
-adjust dosage in response to previous treatment

165
Q

application techniques of LLLT

A

-point application: applied directly over a trigger point, like acupuncuture
-scanning: slow and steady over an area
-grid: draw squares and point at each one

166
Q

indications for LLLT

A

-inflammaiton
-pain
-wound healing
-blood circulation
-muscle function
-adjunctive therapy

167
Q

how does LLLT effect inflammtion

A

-inhibit cyclooxygenase 2, reduce prostaglandin E2
-combine with POLICE to reduce inflammation

168
Q

how does LLLT effect pain

A

-production of endogenous opiates, NO, serotonin, ACh
-effect on nerve conduction velocity and somatosensory evoked potential

-increase NO = increase O2
-endogenous opiates released during descending mechanism (pain inhibitoin)
-serotonin released during descending to also inhibit pain
-ACh inhibitory neurotransmitter, increases pain threshold

169
Q

how does LLLT effect wound healing

A

-treatment of ulcers and other skin injuries
-biomodulation: stimulate or inhibit
–stimulates wound healing by increasing good cells
–inhibits bacterial/viral growth and spread
-possible systemic effects

170
Q

how does LLLT effect blood circulation

A

-increase blood flow and dose-response effect
-needs additional research

171
Q

how does LLLT effect muscle function

A

-increase ATP production
-reported effects related to delaying fatigue during and improving recovery after exercise

172
Q

how does LLLT effect adjunctive therapy

A

-cool tissues before LLLT and heat after
-may not benefit from combo treatments or while on certain meds

173
Q

safety considerations with LLLT

A

-eye safety: never look into the laser, wear eye protection
-training: proper training required
-cell proliferation: determine appropriate dosage for child vs adult
-fatigue reactions: usually short-term
-pain response: may occur the following day, positive response sign

174
Q

contraindications of LLLT

A

-pregnancy
-cancer
-children
-steroid usage (topical steroids may burn them)

175
Q

T/F moving LLLT over an affected area is similar to ultrasound

A

true

176
Q

which gate control mechanism does LLLT evoke

A

descending mechanism

177
Q
A

KNAT 522 (6 decks)

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