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Passive Care > Final-2 Neuromuscular Control/Biofeedback > Flashcards

Final-2 Neuromuscular Control/Biofeedback Flashcards

1
Q

Categories of pain

A

Nociceptive: somatic or visceral
Neuropathic: peripheral or central
Psychogenic
Carcinogenic

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2
Q

Kubler-Ross death and dying model

A

DABDA
5 states of response to terminal illness
Denial, anger, bargaining, depression, acceptance

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3
Q

Cognitive appraisal models to injury

A

Response to injury depends on understanding of injury and not neatly divided into stages

**reponse to injury influenced by actions/message of doctor

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4
Q

Parts of cognitive appraisal models with injury

A
  1. Ability to cope with injury influenced by family, friends, stress level etc
  2. Knowledge and understanding alter the response
  3. Find the right level
    (Don’t oversimplify but don’t overwhelm)
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5
Q

Using EPAs and reducing pain thoughts

A
  • 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
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6
Q

Peripheral sensory receptors categories

A

Special
Visceral
Superficial
Deep

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7
Q

Superficial peripheral sensory receptors

A

Sight, taste, smell, hearing and balance

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8
Q

Visceral peripheral sensory receptors

A

Hunger
Nausea
Distension
Visceral pain

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9
Q

Superficial sensory receptors

A

Mechanoreceptors and thermoreceptors

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10
Q

Mechanoreceptors

A

Meissner’s corpuscles (pressure and touch)
Pacinian
Merkle cells (skin stretch/pressure)

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11
Q

Deep sensory receptors

A

Proprioceptors

Nociceptors

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12
Q

Proprioceptors

A

GTO: change in muscle length and spindle tension

Pacinian: change in joint position

Ruffini endings: joint end range

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13
Q

Meissner’s

A

Pressure and touch

Mechanoreceptor, superficial sensory

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14
Q

Merkle

A

Mechanoreceptor-superficial sensory

Stretch and pressure

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15
Q

GTO

A

Proprioceptors-deep sensory

Muscle length change and spindle tension

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16
Q

Pacinian

A

Proprioceptors-deep sensory

Change in joint position

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17
Q

Ruffini endings

A

Proprioception-deep sensory

Joint end range, possible heat

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18
Q

Transduction

A

Changing energy of nociception into electrical action potential in the neuron

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19
Q

First order afferents-peripheral transmission of pain

A

AB
AD
C

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20
Q

A-beta fibers what receptors?

A

Hair follicles, meissner’s, pacinian, merkle, ruffini

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21
Q

Characteristics of AB fibers

A

Touch, vibration

  • large diameter
  • myelinated (fast velocity and low threshold)
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22
Q

AB transmit what information

A

Touch vibration

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23
Q

AD transmit what information

A

Touch, pressure, temperature, pain

24
Q

AD receptors

A

Warm and cold receptors, hair follicles, free nerve endings

25
Q

Characteristics of AD fibers

A

Myelinated

Smaller diameter than (AB) so slower velocity

26
Q

C fibers transmit what

A

Touch, pressure, temperature, pain

From MUSCLE and skin

Unmyelinated and small diameter (SLOW)

27
Q

Peripheral transmission refers to what anatomy?

A

Peripheral nerve fiber

Cell body in DRG and synapse in spinal cord

28
Q

Central transmission anatomy

A

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
29
Q

Parts of thalamus important for pain

A

VPL and VPM

30
Q

VPL

A

Ascending pain fibers from body synapse here

31
Q

VPM

A

Fibers from head and face synapse (pain)

32
Q

Thalamus and pain

A

Modulated input and transmits to somatosensory cortex

Relays to Limbic system (emotion, autonomic and endocrine responses to pain)

33
Q

Modulation phase of pain

A

Activity after cortex received input of pain

-excitatory/inhibitory role on new impulses

Hypothalamus, pituitary, reticular formation, raphe nucleus

34
Q

Anatomy involved of modulation phase

A

Hypothalamus, pituitary, raphe nucleus, reticular formation

If not inhibited may exacerbate pain and lead to “windup”

35
Q

Peripheral pain modulation

A

Targeted at desensitizing peripheral nocioceptors to make more difficult to stimulate and slower transmission

Ex: Ice —decrease effects of chemical mediators and decrease speed

36
Q

Peripheral pain modulation-gate theory

A
  • 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)

37
Q

What fiber is responsible for gate theory that inhibits pain

A

AB

Stimulate AB fibers to inhibit pain (recall touch and vibration)

TENS (ERA method)

38
Q

Central pain modulation

A

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)

39
Q

Central pain modulation path

A

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

40
Q

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

A

Reticular formation
Pituitary
Pituitary releases B lipotropin and B endorphin
Raphe nucleus releases serotonin and enkephalin

41
Q

Noxious pain modulation

A

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

42
Q

Nerve block pain modulation

A

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***

43
Q

Wedenskis inhibition/action potential failure established though what and how

A

Interferential current

Stimulation during refractory period and continual stimulation inhibits

44
Q

Exercise induced hypoalgesia

A

Decreased pain during physical activity

Increased endogenous opioids (endorphins) and catecholamines (EP/NE) during

45
Q

What effect should you consider when evaluating injured athletes

A

EIH

Exercise induced hypoalgesia

46
Q

3 components of neuromuscular control that need to be addressed during rehabilitation

A
  • conscious muscle contraction
  • reflex responses
  • complex movement patterns
47
Q

Example of conscious muscle contraction and shoulder injury

A

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

48
Q

Reflex responses post injury

A

Usually work as portenctive spinal reflex but post injury afferent signals are decreased and lose proprioception

= difficult to reflexively contract and to control balance

49
Q

Complex movement patterns and injury

A

Athlete/piano practice until unconscious pattern and do without thinking.

Injury causes Loss of unconscious patterns

50
Q

Swelling causes what in regards to muscle function

A

Joint effusion sends signals to CNS and inhibit reflexes of muscles

51
Q

When exercises cause pain the ___ _____ change which perpetuates ___ ___ ___ and slows recovery and may lead to more injury

A

Motor patterns

Abnormal motor control

52
Q

What are affected with injury

A 
Balance
Protective reflex
Force output
Joint stability
Position sense
53
Q

Restoring neuromuscular control

A

Active rehab
EPA to give pain free exercises
e-stim for muscle activation
EMG biofeedback for retraining

54
Q

Biofeedback

A

Use of information to bring physiological events to conscious awareness to patient

Ex: mirror, video, EMG, clinician etc, measure stress

55
Q

Electromyographic biofeedback

A

E-activity in muscles detected

  • relearn motor patterns/control
  • relax muscle space and guarding
56
Q

Indicators for electromyographic biofeedback

A

Back, shoulder, knee injury

Learn to control muscles and facilitate contraction

Passive Care (7 decks)

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