Final-2 Neuromuscular Control/Biofeedback Flashcards
Categories of pain
Nociceptive: somatic or visceral
Neuropathic: peripheral or central
Psychogenic
Carcinogenic
Kubler-Ross death and dying model
DABDA
5 states of response to terminal illness
Denial, anger, bargaining, depression, acceptance
Cognitive appraisal models to injury
Response to injury depends on understanding of injury and not neatly divided into stages
**reponse to injury influenced by actions/message of doctor
Parts of cognitive appraisal models with injury
- Ability to cope with injury influenced by family, friends, stress level etc
- Knowledge and understanding alter the response
- Find the right level
(Don’t oversimplify but don’t overwhelm)
Using EPAs and reducing pain thoughts
- reduce pain to enable patient to start therapeutic exercises and allow full functional recovery
- reduce pain to avoid subclinical adaptations that can led to subluxation patterns and long term patients
Peripheral sensory receptors categories
Special
Visceral
Superficial
Deep
Superficial peripheral sensory receptors
Sight, taste, smell, hearing and balance
Visceral peripheral sensory receptors
Hunger
Nausea
Distension
Visceral pain
Superficial sensory receptors
Mechanoreceptors and thermoreceptors
Mechanoreceptors
Meissner’s corpuscles (pressure and touch)
Pacinian
Merkle cells (skin stretch/pressure)
Deep sensory receptors
Proprioceptors
Nociceptors
Proprioceptors
GTO: change in muscle length and spindle tension
Pacinian: change in joint position
Ruffini endings: joint end range
Meissner’s
Pressure and touch
Mechanoreceptor, superficial sensory
Merkle
Mechanoreceptor-superficial sensory
Stretch and pressure
GTO
Proprioceptors-deep sensory
Muscle length change and spindle tension
Pacinian
Proprioceptors-deep sensory
Change in joint position
Ruffini endings
Proprioception-deep sensory
Joint end range, possible heat
Transduction
Changing energy of nociception into electrical action potential in the neuron
First order afferents-peripheral transmission of pain
AB
AD
C
A-beta fibers what receptors?
Hair follicles, meissner’s, pacinian, merkle, ruffini
Characteristics of AB fibers
Touch, vibration
- large diameter
- myelinated (fast velocity and low threshold)
AB transmit what information
Touch vibration
AD transmit what information
Touch, pressure, temperature, pain
AD receptors
Warm and cold receptors, hair follicles, free nerve endings
Characteristics of AD fibers
Myelinated
Smaller diameter than (AB) so slower velocity
C fibers transmit what
Touch, pressure, temperature, pain
From MUSCLE and skin
Unmyelinated and small diameter (SLOW)
Peripheral transmission refers to what anatomy?
Peripheral nerve fiber
Cell body in DRG and synapse in spinal cord
Central transmission anatomy
First order neuron synapses in dorsal horn
- cell body of second order neuron (T CELL) in dorsal horn and many tracts carry info to brain
- cell bodies of third order neurons in thalamus
- VPL and VPM of thalamus for pain
Parts of thalamus important for pain
VPL and VPM
VPL
Ascending pain fibers from body synapse here
VPM
Fibers from head and face synapse (pain)
Thalamus and pain
Modulated input and transmits to somatosensory cortex
Relays to Limbic system (emotion, autonomic and endocrine responses to pain)
Modulation phase of pain
Activity after cortex received input of pain
-excitatory/inhibitory role on new impulses
Hypothalamus, pituitary, reticular formation, raphe nucleus
Anatomy involved of modulation phase
Hypothalamus, pituitary, raphe nucleus, reticular formation
If not inhibited may exacerbate pain and lead to “windup”
Peripheral pain modulation
Targeted at desensitizing peripheral nocioceptors to make more difficult to stimulate and slower transmission
Ex: Ice —decrease effects of chemical mediators and decrease speed
Peripheral pain modulation-gate theory
- non-painful stimulus can block transmission of pain.
- substantia gelatinosa in dorsal horn “switches”
Interneuron uses enkephalin to inhibit transmition within dorsal horn (found in SG)
What fiber is responsible for gate theory that inhibits pain
AB
Stimulate AB fibers to inhibit pain (recall touch and vibration)
TENS (ERA method)
Central pain modulation
Low frequency, high intensity stimulation of peripheral nerves (motor TENS) activate reticular formation and pituitary gland and DEOS (descending endogenous opioid endorphin release) occurs that inhibit effect of pain
Descending pain modulation (analgesia)
Central pain modulation path
AD/C fibers simulated
Stimulate reticular formation that stimulates pituitary. Pituitary inhibits hypothalamus/cortison and stimulated endorphin that stimulated raphe nuclues that releases serotonin and causes enkephalin release
Central pain modulation: AD/C fibers stimulate 2nd order afferent that go to the ___ ____ and stimulate the ____. The ____ releases ___ and _____ which stimulate the ____ nucleus and causes release of _____, _____ that inhibit pain
Reticular formation
Pituitary
Pituitary releases B lipotropin and B endorphin
Raphe nucleus releases serotonin and enkephalin
Noxious pain modulation
Stimulation of C fibers in injury area (Noxious TENS)
Activates PAG (periaqueductal gray space) and raphe nucleus. Serotonin in dorsal horn inhibit second order neuron directly or through interneuron (enkephalin)
Ex: ice, stimulate C fibers during burning and aching sensation
Nerve block pain modulation
When stimulation encroaches on refractory period of sensory nerve and causes inhibitiation by continual stimulation
“Wedenskis inhbition/action potential failure”
=anesthesia between electrodes aka IF***
Wedenskis inhibition/action potential failure established though what and how
Interferential current
Stimulation during refractory period and continual stimulation inhibits
Exercise induced hypoalgesia
Decreased pain during physical activity
Increased endogenous opioids (endorphins) and catecholamines (EP/NE) during
What effect should you consider when evaluating injured athletes
EIH
Exercise induced hypoalgesia
3 components of neuromuscular control that need to be addressed during rehabilitation
- conscious muscle contraction
- reflex responses
- complex movement patterns
Example of conscious muscle contraction and shoulder injury
Shoulder injury preventing motion= substitute upper trap muscle and cause inhibition of lower trap
Inability to voluntarily contract and causes muscle atrophy and then scapular instability
Reflex responses post injury
Usually work as portenctive spinal reflex but post injury afferent signals are decreased and lose proprioception
= difficult to reflexively contract and to control balance
Complex movement patterns and injury
Athlete/piano practice until unconscious pattern and do without thinking.
Injury causes Loss of unconscious patterns
Swelling causes what in regards to muscle function
Joint effusion sends signals to CNS and inhibit reflexes of muscles
When exercises cause pain the ___ _____ change which perpetuates ___ ___ ___ and slows recovery and may lead to more injury
Motor patterns
Abnormal motor control
What are affected with injury
Balance Protective reflex Force output Joint stability Position sense
Restoring neuromuscular control
Active rehab
EPA to give pain free exercises
e-stim for muscle activation
EMG biofeedback for retraining
Biofeedback
Use of information to bring physiological events to conscious awareness to patient
Ex: mirror, video, EMG, clinician etc, measure stress
Electromyographic biofeedback
E-activity in muscles detected
- relearn motor patterns/control
- relax muscle space and guarding
Indicators for electromyographic biofeedback
Back, shoulder, knee injury
Learn to control muscles and facilitate contraction
