Intro Lecture

Question 1

Name 5 clinical applications for Therapeutic Modalities?

Answer 1

1) modulate pain
2) facilitate/inhibit altered skeletal muscle
3) decrease inflammation
4) facilitate tissue healing
5) increase extensibility

Question 2

In what phase of rehab can US be used?

Answer 2

In early stage after an injury: to decrease inflammation/swelling/compression and to facilitate reparative physiological processes

When you need assistance because you cannot perform parts of your intervention plan.

Question 3

Name an example of how modalities can increase the effectiveness of other interventions.

Answer 3

hot pack prior to stretching can aid tissue extensibility

Question 4

Which modalities can help reduce pain What outcome measures would you use?

Answer 4

Cryotherapy
thermotherapy
ultrasound
Electrical stimulation

Pain scales
Functional scales that have a pain component

Question 5

Which modalities can help increase strength? Which outcome measures would you use?

Answer 5

NMES
Biofeedback

MMT
Dynamometry
Functional Tests

Question 6

Which modalities can help decrease swelling/inflammation? Which outcome measures would you use?

Answer 6

Cryotherapy
Compression

Girth
Circumferential measurements
volumetrics

Question 7

What modality can help increase tissue healing when integument is compromised? Which outcome measure would you use?

Answer 7

Electrical Stimulation

Tissue Healing (closure time, wound depth)

Question 8

Which modalities would you used to increase ROM/flexibility? Which outcome measure would you use?

Answer 8

Thermotherapy
Diathermy
Ultrasound

Goniometric measurements

Question 9

Name contraindications/precautions for modalities?

Answer 9

Contraindications:
comprised/impaired/diminished sensation
electronic implants
Precautions:
compromised/impaired/diminished cognition
pregnancy
cancer

Question 10

What is acute pain?

Answer 10

a response to a noxious stimuli that generally lasts less than 6 months and the underlying pathology can be identified.

Question 11

What is chronic pain?

Answer 11

pain that persists beyond the normal time for healing, some say longer than 3 or 6 months.
early id of those at risk (prolonged, severe, disabling acute pain)

Question 12

What is referred pain?

Answer 12

pain that is felt distant to the source
is referred from one joint to another from a peripheral nerve to a distal area of innervation OR internal organ to an area of musculoskeletal origin.

Question 13

How do you tell if the source of the pain is located in the same area as where it is sensed?

Answer 13

musculoskeletal pain in origin varies with position or movement of the painful area

pain caused by other systems generally varies with stress on that system

Question 14

What else do you want to know if Pt complains of pain?

Answer 14

specific location
quality
severity (intensity)
timing/duration
what makes it better/worse
how does it affect function/activity/participation

Question 15

What’s the current theory of pain reception?

Answer 15

Quality of pain depends on the type of tissue from which stimulus orignates and on which of the 2 nerve types transmits the pain. nociceptors –> A-deta fibers or C fibers –> spinal cord.

Intensity of pain is related to the rate of firing.

Question 16

If pt perceives pain as sharp, pricking, tinging, easy to localize, what is likely the stimulus source?

Answer 16

cutaneous noxious stimulation

Question 17

If pt perceives pain as dull, heavy, aching, hard to localize, what is likely the stimulus source?

Answer 17

musculoskeletal structures

Question 18

If pt perceives pain as aching by more superficial, what is likely the stimulus source?

Answer 18

visceral pain

Question 19

If pt perceives pain as sharp, what is likely the nerve type being stimulated?

Answer 19

A-delta fibers

Question 20

If pt perceives pain as dull, long lasting and aching, what is likely the nerve type being stimulated?

Answer 20

C fibers

Question 21

What nerve type normally does not transmit pain?

Answer 21

A-beta

Question 22

What type of stimuli activate C fibers and how quickly do C fibers transmit signals?

Answer 22

mechanical, thermal, chemical

1m/sec

Question 23

What type of stimuli activate A-delta fibers and how quickly do A-delta fibers transmit signals?

Answer 23

high intensity mechanical

5-30m/sec bc they are myelinated.

Question 24

What’s the path that pain signals take to brain?

Answer 24

C/A-delta fibers in spinal nerve–> dorsal root ganglion –> dorsal horn –>spinal thalamic tracts –> brainstem –> thalamus –> cerebral cortex

Question 25

pain loop

Answer 25

nociceptor stimulated –> axon–>T call in dorsal horn –> anterior horn cell –> stimulates muscle fiber contraction –> nociceptor stimulated

Question 26

What are two ways our bodies modulate pain?

Answer 26

1) Gait control theory - pain sensation is determined by a balance of excitatory and inhibitory inputs to the T cells in the spinal cord. (nonnociceptive A-beta fibers stimulate inhibitory interneurons)
[how many modalities work]

2) Endogeous Opoid System - opiates like peptides- opiopeptins (endorphins) bind to opiate receptors

Question 27

What should you document?

Answer 27

• modality used
• area of body treated
• intervention duration
• parameters- position of the patient, use of concurrent compression/elevation
• outcomes- progress toward goals, regression/ complications (change skin appearances, pt response, adverse responses)
• CPT Codes