1. Shock 2. Distress 3. Disorganization 4. Acceptance

Intro Flashcards by Caitlyn Hauswirth

Loss cylce

Shock
Distress
Disorganization
Acceptance

How well did you know this?

Not at all

Perfectly

Shock

Physical effects (sleep, numbness, irritable)
poor awareness of physical limitations
Goal: pt safety
Intervention: normalize breathing, decrease tension, pt ed on loss cycle

How well did you know this?

Not at all

Perfectly

Distress

Emotional effects (angry, sad, helpless)
Goal: Support and understanding for pt's emotional hurt
Intervention: express feelings into words, pain diary

How well did you know this?

Not at all

Perfectly

Disorganization

Mental Effects (depression, suicidal, hopeless)
decreased focus and cognitive ability
Goal: assist pt to be active within limits - provide structure
Intervention: set clear limits, engage support systems

How well did you know this?

Not at all

Perfectly

Acceptance

Integration - ready to learn/maximize recovery
-Positive feelings, lessons learned, future planning
Goal: guide the rehab process

How well did you know this?

Not at all

Perfectly

Stress is

Stress is a state of disharmony, and is a state of threatened homeostasis

How well did you know this?

Not at all

Perfectly

Autonomic NS compensation

increased adrenaline production

How well did you know this?

Not at all

Perfectly

CNS compensation

increased nociceptive representation

How well did you know this?

Not at all

Perfectly

Immune system compensation

chronic inflammation

How well did you know this?

Not at all

Perfectly

Peripheral NS compensation

increased number of nociceptors

How well did you know this?

Not at all

Perfectly

Wolf’s Law

Arrangement of connective tissue structures and specialization of their fibers are directly related to stresses placed on them.
Forms structures of varying densities and functions which include bone, cartilage, blood cells and blood forming tissue, adipose tissue, tendons, ligaments.

How well did you know this?

Not at all

Perfectly

What are the regular connective tissues?

tendons and ligaments

How well did you know this?

Not at all

Perfectly

Regular connective tissue: Tendon

Arranged in parallel fibers of collagen
Continuum of muscle
Held together by cross fibers and bound by a layer of loose connective tissues

How well did you know this?

Not at all

Perfectly

Regular connective tissue: ligaments

Tough, pliant, flexible without resisting movement.
Unyielding
Less regular vs tendons: spiral and oblique arrangement

How well did you know this?

Not at all

Perfectly

What is irregular connective tissue?

Fascia - dense and loose connective tissue

How well did you know this?

Not at all

Perfectly

Composition of fascia

Irregular sheaths of collagen and elastin that are continuous with each other.
-include all structures from basement membrane of dermis to periosteum of bone.

How well did you know this?

Not at all

Perfectly

Characteristics of fascia

superficial thinner/delicate to allow for skin movement

- deeper thicker/stronger, separating surrounding structures

How well did you know this?

Not at all

Perfectly

Organization of fascia fibers

Sheaths and fibers lay at angles to each other: provide greater strength and extensibility/flexibility

How well did you know this?

Not at all

Perfectly

Functional joint

space between structures created by fascia - a space built for motion

How well did you know this?

Not at all

Perfectly

6 Functions of fascia

Separate structures
Absorbs shock
Exchange of metabolites
Energy storage
Protect against spread of infection
Allows for normal muscle play

How well did you know this?

Not at all

Perfectly

3 Components of Fascia

collagen
elastin
reticulin (anchors structures)

How well did you know this?

Not at all

Perfectly

Most common/prolific fiber of loose connective tissue

Collagen

How well did you know this?

Not at all

Perfectly

Tensile strength of collagen

High tensile strength

Withstands 50% that of bone

Where is collagen found?

Tendon, ligament, fascia, and capsules

What is needed for efficient production of collagen?

- Vitamin C (hydroxylation of proline) | - Regular stress

What can impair collagen production?

- Steroids | - Impaired within distribution of nerve impingements

What type of collagen is treated with STM?

Type 1 collagen

2 elements responsible for formation and health of connective tissues

1. Fibroblasts | 2. Ground substance

Fibroblasts

most prolific of cellular elements, responsible for collagen synthesis

Make up of collagen

proline + lysine + glysine = tropocollagen Tropocollagen aligns and forms collagen -Hydrostatic covalent bond

Ground Substance

Non-fibrous element of connective tissue matrix

Extracellular matrix of ground substance made by

fibroblasts

Ground substance made of

- Long changes of water and carbohydrates | - Carbs made of GAGs, proteoglycans, and collagen

Glycosaminoglycans (GAGs) importance

- important for STM - Composed of: - -non-sulfated hyaluronic acid (holds water/lubricates and prevents abnormal cross-links) - -chondroitin sulfates (determines cohesiveness, viscosity, and rigidity of tissues)

Water component of ground substance

-Facilitates diffusion of metabolites, electrolytes, and gasses between cells and vascular/lymphatic systems

How to keep connective tissues healthy

Frequent mobility of tissues to maintain normal lubrication and critical fiber distance

Decreased mobility of ground substance related to

- dehydration | - decreases with age, immobility, atrophy, trauma

Macrophage

phagocytic action on bacteria, foreign bodies, damaged tissues, 2nd most numerous cell

Lymphocytes and plasma cells

make antibodies

Mast Cells

release histamine and serotonin - agents in inflammatory changes and heparine - anticoagulant

Types of connective tissue

1 macrophage 2 lymphocytes and plasma cells 3 mast cells 4 fat cells

Intermolecular cross-linking: immobilization

30-40% reduction in GAGs in ground substance leading to dehydration

Effect of dehydration on critical fiber distance

Decreases critical fiber distance and lubrication between fibrous elements increasing resistance to movement

Intermolecular cross linking may occur

Between fibers of functional intercept points, further limiting extensibility of tissues

Body's response to trauma, infection, or immobilization

Increased crosslinks, decreased tissue extensibility

Inflammatory stages

-Leukocytes and macrophages begin phagocytic action against bacteria

Fibrogenesis stage

Fibroblasts proliferate and begin this stage, begins process of scar tissue formation and healing

No motion in reparative process may produce...

Non-neoplastic fibrous tissue that is immobile and restrictive

Days 3-21

High scar tissue production

Weeks 6-8

poor tensile strength

Week 14

poor scar elongation

6mo-1yr

90-100% of tensile strength returns

Possible reasons for pain/injury/inflammation related to soft tissue mobility

- Intermolecular cross linking - Scar tissue adhesions - Ground substance dehydration - Lymphatic stasis - Neuroreflexive causes - Electrochemical causes

Possible causes for improved mobility following STM

- Mechanical: breaking of cross links - Mechanical: alteration of scar tissue matrix - Viscoelastic: mechanical elongation of collagen tissue - Hydration: redistribution of interstitial fluids - Stimulation of GAG synthesis, reinstatement of normal lubrication and hydration, neuroreflexive changes, electrochemical changes

Precautions and contraindications to STM

New scar, fragile skin, active inflammatory response, open wound, malignancy, active infection, obstructive edema, aneurysm, acute RA, osteomyelitis, advanced osteoporosis, advanced diabetes, fibromyalgia during exacerbation, fracture

Degenerative cascade

Kolby