Exam 1 Flashcards
Why is cryotherapy used?
used to reduce the inflammatory response (pain & swelling) after acute injury and reduce the metabolic demand of the damaged tissues, and reduce muscle activity
What effects do LOCAL cold applications produce?
Local vasoconstriction w/ a reduction in blood flow
Decreased local metabolism and demand for oxygen
Decreased microvascular permeability w/ decreased tissue edema
Slowed nerve conduction velocity
Increase pain threshold
Release of endorphins
Diminished muscle spindle activity
Decreased maximal voluntary muscle torque & rate of peak torque development
Impaired manual dexterity (through increased muscle viscosity)
Stiffened connective tissue; decreased tensile strength
What does a general application of cold mean?
A cold application is applied over a large portion of the body
What effects do GENERAL cold applications produce?
Generalized vasoconstriction in response to cooling of the post. hypothalamus
Slowed respiratory & heart rates
Increased muscle tone accompanied by shivering
Increased metabolism with prolonged applications to produce heat and maintain homeostasis
What are indications for cryotherapy?
Spasticity w/ increased muscle tone Early acute injury or inflammation Chronic painful conditions (RA, osteoarthritis, adhesive capsulitis, post-surgery) Emergency care for small burns Edema
Name the contraindications for cryotherapy?
Patients w/ angina pectoris or other cardiac dysfunction
Open wounds
Arterial insufficiency (Raynaud’s, atherosclerosis)
Cold urticaria (hives)
Patients w/ preexisting anesthetic skin or inability to communicate
Regenerating peripheral nerves
List the precautions for the use of cryotherapy?
Extremes of age
Raynaud’s phenomenon
Hypersensitivity to ice
Over superficial peripheral nerves over which there is minimal subcutaneous fat
Proprioception & throwing accuracy are diminished following 20 minutes of ice
Recommendations to reduce swelling and metabolism?
Use mild applications
Combine cold applications w/ compression & elevation
Why is cryotherapy contraindicated for older adults and young children?
Older adults = less efficient in generating heat & lose heat more readily
Children = risk of hypothermia is higher
Which disease is triggered by exposure to cold?
Raynaud’s phenomenon
produces pain & decreases finger dexterity
What area of the body must you avoid prolonged ice applications of 20 minutes or greater? What may happen if this occurs? What can be done to minimize the effects?
Superficial peripheral nerves over which there is minimal fat
It may cause never injury and nerve degeneration
If contact is unavoidable increase padding or layer to the cold application
If a patient is hypersensitive to ice what may occur? How can we test for this?
Wheals or hives may result.
Test a small area of skin, if reaction occurs, document the reaction and do not use ice as an intervention
In athletes, what is diminished following 20 minutes of ice application?
Proprioception and throwing accuracy
Joint stability may be affected
Avoid return to play immediately following ice application
Why is cryotherapy contraindicated for application to open wounds?
Because of the vasocontriction produced by cold
Cryotherapy should not be used for the first 48 to 72 hours after injury
Why is cryotherapy contraindicated for patient with arterial insufficiency (atherosclerosis & Raynaud’s disease)
Vasoconstriction diminishes ability to meet oxygen demands of tissues
Why should we avoid a cold application to patients with preexisting anesthetic skin or inability to communicate?
They cannont report when they become anesthetic from cold
What is the difference in temperature that produces anesthesia and temperatures that produce tissue damage?
Anesthesia = 27 degrees C/ 80.6 degrees F
Tissue damage = 10 to 25 degrees C/ 50 to 77 degrees F
In a general cold application the inability to meet myocardial oxygen demands is a contraindication for which patient?
Patient’s with angina pectoris or other cardiac dysfunction
Why is cryotherapy contraindicated for patients with regenerating peripheral nerves
Cold exposure has been shown to produce transmission failures, potentially through depolarization block
Would you use cryotherapy for a patient in need of emergency care for small burns? If so, why?
Yes.
The use of cool water or a moist towel initiated immediately has proved to be effective
Do not use ice
Why is cryotherapy used in early acute injury or inflammation conditions?
Reduce inflammatory response (pain, swelling, muscle guarding)
Reduces arthrogenous muscle inhibition that occurs with intra-articular swelling
How do patient’s with a total knee arthroplasty benefit from cryotherapy?
Experience less pain, analgesic use, and blood loss
Increased ROM with continuously applied cold for 6 days
How do patient’s with chronic painful conditions benefits from cryotherapy?
Reduced pain and stiffness allowing for better movement
How does a cold application benefit patients with muscle spasticity?
Local cooling reduces the excitability of monosynaptic reflexes
Explain the how cryotherapy assists patients suffering from edema?
Decrease vascular permeability and extravasation of fluid into interstitial tissue
What are the benefits of thermotherapy?
Increased metabolism, body temp, pulse rates, & respiratory rate
Increased perspiration to area, capillary pressure & cell permeability (can promote local swelling)
Increase in oxygen tension w/ increased tissue temp
Local vasodilation in response to increased demands for nutrients
Muscle relaxation
Sedation of sensory nerve endings
In conjunction w/ stretching can increase extensibility of connective tissue
How is thermotherapy beneficial for patient’s w/ subacute chronic conditions?
Reduced trigger point pain, muscle stiffness, greater flexibility, improved function
Explain the benefits of thermotherapy for pts. w/ osteoarthritis and RA?
Increased ROM, grip strength (w/ paraffin intervention), flexibility, and mobility.
Decreased levels of pain
Why is thermotherapy used w/ electrical stimulation?
To stimulate perspiration to decrease skin impedance and improve electrical conductivity of skin
In cases where pts. have tightened connective tissue such as scar and joint contracture how is thermotherapy beneficial?
Increase soft tissue extensibility
Application of heat prior to and simultaneous with low load prolonged stretching or mobilization exercises
How thermotherapy benefit pts. w/ sickle cell anemia?
Shorter hospital stays
Decreased use of analgesics
Increase ROM
List the indications for thermotherapy?
Subacute & chronic conditions (carpal tunnel, LBP, trigger points)
Osteoarthritis & RA
Tight connective tissue (scars & joint contractures)
Dysmenorrhea
Prior to e-stim
Sickle cell anemia
List the contraindications for thermotherapy?
Areas w/ acute inflammation Active bleeding Malignancies Peripheral vascular disease Following denervation or surgical repair Thrombophlebitis Confusion, sedation, or coma Areas w/ sensory loss Existing fever Tissues that are devitalized by x-ray therapy
Why would thermotherapy be problematic for pts. who are confused, sedated, or in a coma?
Judgement of heat levels is unreliable, and ability to follow safety instructions is diminished
What may result from a heat application to a pt. w/ malignancies?
Malignancies may metastasize as a result of the increase blood flow and tumor metabolism produced by heating
Why is active bleeding a contraindication for thermotherapy?
Vasodilation and rate of flow may be prolonged
If a patient has a fever why would thermotherapy be contraindicated?
May further elevate temperature
Explain what problem may arise if thermotherapy is applied to pts. w/ thrombophlebitis?
Increased blood flow could dislodge clot
Why is thermotherapy contraindicated for pts. w/ peripheral vascular disease?
circulation has diminished capacity to meet the increased metabolic demands if tissues in the affected extremities are heated directly
How does heat affect pts. w/ acute inflammation?
increased blood and edema may aggravate the inflammation
What problems may arise if heat is applied to pts. w/ areas of sensory loss?
Judgement of heat levels is unreliable and vascular supply may be diminished
Why is thermotherapy contraindicated for pts. w/ tissues that are devitalized by x-ray therapy?
Tissues can not tolerate temperature changes
Explain what may occur if thermotherapy is applied to the abdomen or low back during pregnancy?
Increasing core temp increases risk of miscarriage & could harm fetus
Explain why older adults and children less than 4 should avoid thermotherapy?
Thermoregulatory systems are unreliable and fever may develop quite easily as a result of heat treatments that trigger central mechanisms to dissipate heat
List the precautions for thermotherapy?
Heat application to abdomen or low back during pregnancy
Older adults & children less than 4
Cardiac insufficiency
Existing edema
Over areas on which topical counterirritants have been applied
Over implanted metal close to the skin
Explain why thermotherapy applied over implanted metal close to the skin is a precaution?
high thermal conductivity could cause burns
Why should pts. w/ cardiac insufficiency avoid thermotherapy?
additional stress on the heart produced by heat treatments that trigger central mechanisms to dissipate heat may not be able to tolerate
Use milder forms of heat over small areas and monitor carefully
Why should pts. w/ existing edema avoid thermotherapy?
Heat may aggravate
Use elevated positions and mild heat intensities
What are noxious stimuli?
Stimuli that activate nociceptors (pressure, cold/ heat extremes, chemicals)
What is analgesic?
a neurological or pharmacologic state in which pain stimuli are no longer painful
Describe the accommodation phenomenon?
Adaptation by the sensory receptors to various stimuli over an extended period of time
Less sensitive to stimuli
What are nocioceptors?
Nerve receptors that transmits pain impulses
They can be activated by intense thermal, mechanical, or chemical stimuli from exogenous or endogenous sources
Where are nocioceptors present?
In almost any type of tissue
What is the process of transduction?
when nocioceptors are activated they convert the initial stimulus into electrical activity, in the form of action potentials
What is parathesia?
abnormal sensation
ie- burning, pricking, tingling
These types of nerves send impulses from the periphery TOWARD the CNS
afferent nerves
Name the two types of primary afferent neurons?
C- Fibers and A-delta fibers
What is hyperesthesia?
abnormal acuteness of sensitivity to touch, pain, or other sensory stimuli
What is pain threshold?
The level of noxious stimulus required to alert an individual of a potential threat to tissue
Describe A- delta fibers?
Small, MYELINATED nerve fibers that transmit pain quickly to the CNS
Pain transmitted by these fibers has a sharp quality!
What are C- fibers?
small, UNMYELINATED nerve fibers that transmit pain slowly to the CNS
Pain transmitted by these fibers is usually dull, long-lasting, and aching
What does inhibition mean? What is an inhibitor?
Depression or arrest of a function
An agent that restrains/ retards physiologic, chemical, or enzymatic action
What is pain?
The activation of noxious stimuli (called nocioception)
The sensory experiences, suffering, and alterations in behavior associated w/ nocioceptive activation
Explain how the nociceptors send pain impulses back to the CNS?
When a noxoious stimuli is sense nociceptors transmit the sensation of pain along C-fibers & A- delta fibers to the DORSAL horn of the spinal cord to the THALAMUS to the CORTEX
What are efferent nerves?
Nerves that conduct impulses from the CNS to the periphery
What does PCA stand for?
Patient controlled analgesia
How is pain transmitted?
Via nerves and neurotransmitters
Which neurotransmitters send FAST pain signals back to the CNS?
A- delta fibers (myelinated)
ie- sharp, stabbing, pricking
Quick to diminish
Name the slower acting pain signal neurotransmitter?
C- fibers (unmyelinated)
ie- Dull, throbbing, aching, tingling, burning, tapping
Slow onset, longer lasting
What is the FASTEST signaling primary afferent neuron?
A- beta fibers (myelinated)
relatively large
Transmit vibration, stretching of skin, mechanoreceptor
Fire in the same pathways as C- fibers
Name the first order neurons?
A- alpha
A- beta
A- Delta
C- fibers
What is the spinal cord pathway?
Afferent nerves > interneurons > into efferent nerves of anterior horn of the grey matter of the spinal cord (substantia gelatinosa) > T cells > inhibition of pain from NONNOCICEPTIVE afferents aka Pain gating
Describe the cerebral pathway of pain?
Nociocepter actviation > Afferent nerves >
dorsal horn of SC > Interneurons > anteriospinothalamic or lateralspinothalamic tracts on contralateral side > ascend to brainstem & thalamus >
connections to primary somatosensory strip of cortex =
Pain signals are interpreted!
Describe second order neurons?
Receive impulses from FON in the dorsal horn
Lamina II, Substania Gelatinosa determines input sent to T cells from peripheral nerve (gating area)
T cells connect sensory nerve to CNS
Neurons organize stimulus input & transmit stimulus to the brain
Ends in thalamus
Describe third order neurons?
Begins in Thalamus > Ends in cerebral cortex
Perceives pain location, quality & intensity
Allows to feel pain intergrate and determine reaction to stimulus
Explain descending neurons?
Transmit impulse from brain to spinal cord > Periaquaductal gray area (PGA) releases enkephalins & Nucleus Raphe Magnus (NRM) release serotonin
The release of these neurotransmitters inhibits ascending neurons - causing analgesia
Name 2 endogenous opioid peptides?
Endorphins and enkephalins
What are enkephalins?
Pentapeptides that are naturally occuring in the brain and that bind to opioid receptors producing analgesic effects
What are the two types of neurotransmitters that mediate pain?
Endorphins- morphine like neurohoromone thought to increase pain threshold by binding to receptor sites
Serotonin- substance that causes local vasodilation and increases permeability of capillaries
Both are generated by noxious stimuli
What are neurotransmitters?
Chemical substances found in synapses that allow nerve impulses to move from one neuron to another
List the neurotransmitters involved with pain control?
Substance P Acteylcholine Enkephalins Norepinephrine Endorphins Serotonin
What are synapses?
The site of functional connection between neurons where an impulse is transmitted from the presynaptic neuron to the postsynaptic neuron usually by a chemical neurotransmitter
Describe substance P?
Thought to be responsible for the transmission of pain producing impulses
Name the neurotransmitter responsible for transmitting motor nerve impulses?
Acetylcholine
What does norepinephrine do?
causes vasoconstriction
When a nociceptor is excited by stress and tissue it is ________?
Mechanosensitive
What is difference between primary & secondary hyperalgesia ?
Primary = Due to injury Secondary = due to spreading of chemical mediators
What is hyperalgesia?
increased sensitivity to noxious stimuli
What is the gate control theory of pain modulation?
The theory that pain is modulated at the spinal cord level by inhibitory effects of innocuous afferent input
In the gate control theory explain what happens if A- beta neuron are stimulated?
Substantia Gelatinosa (SG) is activated which closes that spinal gate to A- delta & C- neurons reaching the cerebral cortex = DECREASING pain
In the gate control theory explain what happens if A- delta & c-neurons are stimulated?
SG is blocked which closes the gate to A-beta neurons allowing for INCREASED pain to reach the cerebral cortex
Explain the Central Biasing Theory?
The body uses past experiences with pain to judge the intensity/severity of current pain
It is used on sharp chronic pain or severe pathological pain
How does the central biasing theory respond to painful stimuli?
Descending neurons are activated by stimulation of A-delta & C-neurons, cognitive processes, anxiety, depression, previous experiences, and expectations > causes release of enkephalins (PAG) & serotonin (NRM) > Enkephalin from interneuron in area SG blocks A-delta & C neurons
Describe the Endogenous Opiates theory?
Release of opiopeptins (previously endorphins) in peripheral nerve endings and in CNS indirectly inhibit pain transmission by blocking chemicals (GABA and Substance P) whose job is to facilitate pain transmission
Mechanism of action is similar to enkephalins to block ascending nerve impulses
ex: Noxious TENS & accupuncture
Which type of pain is conducted through rapidly conducting pathways?
Acute pain
What are the physiological responses to acute pain?
Increases in muscle tone, HR, BP, skin conductance & other indicators of increase sympathetic nervous system activity
What are physical agents?
consist of energy & materials applied to patients to assist in rehab
What is another name for physical agent?
modality
What are some examples of thermal agents?
hot packs, ice packs, ultrasound, whirlpool, diathermy
What are some examples of mechanical agents?
traction, compression, water & sound
Can physical agents fall in more than one category?
Yes, ex: water & ultrasound both have mechanical & thermal effects
What is the difference between cryotherapy and thermotherapy?
cryo-therapeutic application of cold
thermo- therapeutic application of heat
Hot pack produces the greatest temperature in which tissues?
superficial with high thermal conductivity in the area directly below it
Why would pulsed ultrasound be used instead of continuous ultrasound?
pulsed is used to facilitate tissue healing or promote transdermal drug penetration by non thermal mechanisms. Continuous would be used to heat deep tissues, increase circulation, metabolic rate, soft tissue extensibility and decrease pain
What type of physical agent is water? And why might it be used?
mechanical agent. Provide resistance f, hydrostatic pressure and buoyancy for exercise, also pressure to clean open wounds
What does traction do?
decreases the pressure & compression btw structures such as nerves or joints that may produce pain or sensory changes
What does compression do?
increases the pressure between or on structures, control or reverse edema
What are some examples of electromagnetic agents?
UV radiation, infrared (IR) radiation, laser, diathermy and electrical current
What is the difference between UV radiation and IR radiation?
UV- produces erythema & tanning of the skin but does not produce heat
IR radiation- produces heat in only superficial tissues
Continuous short wave diathermy produces what thermotherapy effects?
produces heat in both superficial & deep tissues
Why would we use pulsed short wave diathermy?
no heat effect needed, modify cell membrane permeability & cell function which contains pain & edema
What is electrical stimulation?
the use of electrical current to induce muscle contraction (motor level ES) & changes in sensation (sensory level ES), reduce edema, or accelerate tissue healing
What parameters are used to change the effect of ES?
wave form, intensity, duration, and direction of the current,
What type of physical agent can at high enough intensity & duration depolarize nerves causing sensory or motor responses that may be used to control pain or increase muscle strength & control?
electrical stimulation (ES)
By modifying the healing process we can accelerate….. which reduces….?(Generally speaking)
accelerate rehab, reduce adverse effects such as prolonged inflammation, pain & disuse & optimize the final patient outcome
How does elecromagnetic agents alter the cell during inflammation & healing?
alter cell function by modifying membrane permeability & transport
Specifically how do physical agents assist during the inflammation phase?
reducing circulation, reducing pain, reducing the enzyme activity rate, controlling motion & promoting progression to the proliferation phase
How do physical agents assist the proliferation phase?
increasing circulation and enzyme activity rate & promoting collagen deposition & progression to the remodeling phase of healing
How do physical agents assist in the remodeling phase of healing?
altering the balance of collagen deposition & resorption & improving the alignment of new collagen fibers
What are the goals of intervention immediately after injury or trauma?
prevent further injury or bleeding & to clean the would contaminates if skin has been broken
What are some examples of devices used to immobilize & support an injured area?
(static compression device) elastic wrap , cast, brace, crutches, wheel chair (assistive device)
Why would you use cryotherapy over thermotherapy during the acute phases of an injury?
Cryotherapy will cause vasoconstriction which will control bleeding and increasing blood viscosity. Thermotherapy would increase blood flow & may reopen vascular lesions w/ vasodilatation
What are the goals of healing during acute inflammation?
control pain, edema, bleeding & the release of activity of inflammatory mediators
What are some physical agents that would be best for controlling pain & reducing edema during the acute inflammation phase?
cryotherapy, compression, sensory level ES, PSWD & contrast bath
A patient is on a high dose of this drug then cryotherapy is contraindicated b/c it could impair the process of inflammation. What drug is it?
catabolic corticosterioids
What are the goals of healing during chronic inflammation?
prevent or decrease joint stiffness, control pain, increase circulation, promote progression to the proliferation phase
How could superficial structures be heated with a pt with chronic inflammation?
hot packs, paraffin
How could deeper structures (shoulder or hip) be heated with a pt suffering from chronic inflammation?
ultrasound or diathermy can be used
What type modalities could be used together to relieve pain for a pt with chronic inflammation?
thermotherapy & ES
Why is cryotherapy generally not recommended for pt’s w/ chronic inflammation?
it can increase the joint stiffness
What are the goals of healing during proliferation?
control scar tissue formation, ensuring adequate circulation, maintaing strength & flexibility & promoting progression to the remodeling stage
How could circulation be enhanced during the proliferation stage?
thermotherapy, electrotherapy, compression & contrast baths
What are the goals of healing during the maturation phase?
regain or maintain strength & flexibility & to control scar tissue formation
This unpleasant sensory & emotional experience can interfere with normal activities (sleep, work or exercise)
pain
How can physical agents control pain?
modifying pain transmission or perception or by changing the underlying process causing the sensation
Physical agents can change the process that causes pain by modifying and altering these aspects of tissue healing
modifying tissue inflammation & healing, altering collagen extensibility or modifying muscle tone
What are some effective physical agents for treating a pt w/ referred pain?
ES, cryotherapy, thermotherapy
What are some effective physical agents for treating a pt w/ spinal radicular pain?
traction
What are the goals of treatment for someone w. spinal radicular pain?
decrease nerve root inflammation & decrease nerve root compression
What are some effective physical agents for treating a pt w/ pain associated w/ malignancy?
ES, cryotherapy, superficial thermotherapy
What modalities would be used for a pt suffering from acute pain & the goal of the treatment is to control inflammation? What would be contraindicated?
cryotherapy
contra- thermotherapy
What modalities would be used for a pt suffering from acute pain & the goal of the treatment is to prevent aggravation of pain? What would be contraindicated?
immobilization, low-load static traction
contra- local exercise, motor ES
Cryotherapy is thought to control acute pain by?
modulating transmission at the spinal cord, by slowing or blocking nerve conduction and by controlling inflammation & it’s associated signs & symptoms
How does sensory level ES relieve acute pain?
modulating transmission at the spinal cord or by stimulating the release of endorphins
What are the shift of the goals of intervention for chronic pain?
resolution of the underlying pathology & control of symptoms to promotion of function, enhancement of strength & improvement of coping skills
How could water water exercise we an helpful modality for pt’s suffering from chronic pain?
increase muscle strength
Chronic pain can be treated with pain controlling physical agents as long as?
these physical agents do not excessively disrupt the patient’s functional activities
Pain caused by malignancy can be tricky to treat b/c?
using certain physical agents (ultrasound & diathermy) may promote the growth or metastasis of malignant tissue.
How could physical agents help pt’s suffering from complex regional pain syndrome?
low-level sensory stimulation of the involved area, neutral warmth, mild cold, water immersion or gentle agitation of fluidotherapy can be effective. Sympathetic nervous system is in hyperdrive
In order to return soft tissue to it’s normal functional length & increasing movement what must be stretched?
collagen
When is the best time for collagen to be stretched?
Most effective & safe when it’s most extensible which is when temp is increased
When soft tissue shortening occurs & the goal of treatment is increase tissue length what are the effective modalities pta could use?
thermotherapy or brief ice massage & stretch
If there is a bony block restricting motion what is the proper physical agent to be used for treatment?
none, patient should not be stretching the blocked joint.
When active motion is restricted by muscle weakness the treatment should be?
aimed at increasing muscle strength
How can increase muscle strength be achieved?
repeated overload muscle contraction through active exercise
What indicates an injury to contractile tissue such as muscle or tendon without complete rupture?
pain restricts motion with active motion only
When pain restricts motion w/ both active & passive motion what type of tissue is involved?
non contractile such as ligament or meniscus
Deep heating agents such as ultrasound or diathermy should be used when motion is restricted by which tissues?
deep tissues such as shoulder joint capsule
When should superficial heating agents such as hot packs, paraffin, warm whirlpools, IR lamps should be used when motion is restricted by which type of tissues?
restricted by shortening of superficial tissues such as the skin or subcutaneous fascia
What is the difference btw ultrasound and diathermy as it is appropriate for either large or small tissue areas?
ultrasound-small areas of deep tissue
diathermy- larger areas
Ice massage & or vapocoolant sprays may be used before stretching to facilitate?
facilitate greater increases in muscle length by reducing the discomfort of stretching but prolonged cryotherapy should not be used b/c it will decrease its extensibility
Although physical agents cannot remove a bony block and should not be used to move the specific joint they may be useful to…?
facilitate increase motion in other joints, but you must avoid injury & hyper mobility in the joint w/ the bone block.
What is muscle tone?
underlying tension that serves as back ground for contraction of a muscle
What is the difference btw CNS injury & peripheral nerve injury in terms of muscle tone affected?
CNS (stroke, CVA) increased or decreased tone in affected area whereas peripheral motor nerve injury it may occur w/ nerve compression, traction or sectioning an decrease muscle tone in the affected area
If the tone is described as hypertonicity and the goal of the treatment is to decrease tone what physical agents would be beneficial?
neutral warmth or prolonged cryotherapy to hypertonic muscles or motor ES or quick ice antagonists
If the tone is described as hypotonicity and the goal of the treatment is to increase tone what physical agents would be beneficial?
Quick ice or motor ES of agonist
If the tone is described as fluctuating and the goal of the treatment is to normalize tone what physical agents would be beneficial?
Functional ES
How can physical agents alter muscle tone?
altering nerve conduction, nerve sensitivity or biomechanical properties of muscle or indirectly by reducing pain or the underlying cause of pain
Why are physical agents contraindicated for a pt who is pregnant?
physiological effects may reach the fetus , adversely affect the fetus
Why is malignancy a contraindication for a physical agent?
physical agents could reach malignant tissue, alter the circulation for that tissue even accelerate the growth or metastasis the tissue
Why is a pacemaker or other electronic implanted device a contraindication for the use of physical agent?
the physical agent could alter the function of the devise which could adversely affecting the patient
Why are impaired sensation & impaired mentation contraindications for physical agents?
pt cannot feel heat or pain b/c impaired sensation or cannot report this sensation accurately & consistently b/c of impaired mentation
When considering the application of a physical agent, one should first check?
physician’s referral
What are precautions?
conditions under which a particular treatment should be applied with special care or limitations
Explain how each portion of RICE helps reduce the inflammation period?
Rest- limits & prevents further injury I-ice reduces circulation & inflammation C-compression elevates hydrostatic pressure outside the blood vessels E-elevation reduces hydrostatic pressure w/in the the blood vessels of the elevated area to decrease capillary filtration pressure @ the atrial end & facilitate venous & lymphatic outflow from the limb
Why are hot packs applied in conjunction w/ mechanical traction?
promotes relaxation of the paraspinal muscles & increase the extensibility of superficial soft tissues in the area in which traction is being applied
Which part of the soap note is this “Pretreatment: pain level 7/10. Forward & side-bending ROM restricted due to pain. Pt unable to lean froward for writing tasks.”
Objective
Which part of the soap not is this “Continue use of hot pack as above before stretching. Continue exercise program.”
Plan
What is phonophoresis?
The application of ultrasound w/ a topical drug to facilitate transdermal drug delivery
Transcutaneous electrical stimulation (TENS) was developed on the basis of which pain theory?
gate control theory of pain modulation that states that non painful stimuli can inhibit the transmission of pain at the spinal cord level.
Wounds heal more rapidly when they are moist or dry?
they are moist
What is described as a goal-oriented intervention designed to maximize independence in individuals who have comprised function
rehabilitation
The ICF model considers these 3 aspects of the person?
the body, the whole person and the person in society
What is evidence based practice?
the conscientious, explicit and judicious use of current best evidence in making decisions abt the care of individual patients.
What does PICO stand for?
P: patient-population I: intervention (time, frequency) C: comparison intervention/measure O:outcome
What are some requirements for cost-effective use of physical agents?
assess & analyze the presenting problem, know when they can be an effective component of treatment, know the skill level required for the application of physical agents, use HEPs when necessary, adjust POC according to reassessments
Lowering the firing threshold of pain transmitting neurons at the spinal cord level caused by increased input from peripheral nociceptors is called?
Central sensitization
What is the technical term for the sensory component of pain?
nociception
Type of pain believed to involve over-activation the sympathetic nervous system
Complex regional pain syndrome
Previously called endorphins, this substance is a peptide that reduces the perception of pain by binding to opiate receptors called ________.
Opiopeptins
Allodynia
pain in response to stimuli that do not usually produce pain
Nerve endings that are activated by noxious stimuli, contributing to the sensation of pain?
Nociceptors
Nociceptor activation results in transmission of cell activation that then stimulated anterior horn cells that will then cause muscles to contract?
Pain spasm cycle
What do elevated levels of substance P indication
increased sensation of pain
Acute pain is generally _________ , ________ , _________.
Less than 6 months duration
Well localized
Mediated through rapidly conducting pathways
What is the specific heat of water?
4.19 J/g/C
What is the specific heat of air?
1.01 J/g/C
What is the specific heat of skin?
3.77 J/g/C
What is the specific heat of muscle?
3.75 J/g/C
What is the average specific heat for the human body?
3.56 J/g/C
What is the specific heat of fat?
2.30 J/g/C
What is the specific heat of bone?
1.59 J/g/C
How do you calculate the rate of heat transfer?
Area of contact X thermal conductivity x temperature difference / tissue thickness
How many layers of toweling should be placed b/t the hot pack and the patient?
6 to 8 layers
*additional layers can be added to limit rate of conduction
How does vapocoolant spray transfer heat from the patient?
Evaporation
Whirlpools and fluidotherapy transfer heat via?
Convection
How do diathermy and ultrasound heat patients?
Conversion
Circulating blood helps keep local body temp at ________. The risk of thermal injury is _________ when circulation is ___________.
Baseline
increased
impaired
How do infrared lamps transfer heat?
Radiation
How long should one apply cryotherapy? And how much rest b/t treatments?
No longer than 20 minutes
at least 1 hours apart
At what temperature does frostbite occur?
4 to 10 degrees C (39 to 50 F)
To avoid tissue damage during cold application tissue temp should be maintain above ________.
15 degrees C (59 degrees F)
What is the typical sequence of sensations in response to cryotherapy?
1 = intense cold 2 = burning 3 = aching 4 = analgesia 5 = numbness
What is the recommended temp range of ice packs?
32 to 41 degrees F
To control spasticity how long should a cold pack be placed? How often should we check the skin?
up to 30 minutes
Check every 10 to 15 minutes
What temp should a hot pack be kept at?
158-167 degrees F (typically 160F is correct)
