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