Lecture Pain and Walking Aids

Question 1

define pain

Answer 1

An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.

*note this definition says absolutely nothing about the cause of pain!!

Question 2

define nociception

Answer 2

The neural process of encoding and processing noxious stimuli. Nociceptive pain = Pain arising from activation of nociceptors

Question 3

define nociceptor

Answer 3

A sensory receptor of the peripheral somatosensory nervous system that is capable of transducing and encoding noxious stimuli.

Question 4

define hyperalgesia

Answer 4

Increased pain from a stimulus that normally provokes pain.

Question 5

define allodynia

Answer 5

Pain due to a stimulus that does not normally provoke pain.

Question 6

define sensitization

Answer 6

Increased responsiveness of neurons to their normal input or neuron response to normally sub-threshold inputs. (peripheral and central)

Question 7

define neuropathic pain

Answer 7

Pain caused by a lesion or disease of the somatosensory nervous system.

Question 8

what is the biopsychosocial model of pain?

Answer 8

• pain influenced by 3 factors, biological, psychological, social

Question 9

what are Pain-related biological, psychological and social inputs are processed by?

Answer 9

the brain

Question 10

is pain an output or inpot of the brain? why?

Answer 10

output!

• inputs don’t cause pain rather pain is dependant on how the brain responds to inputs
• How our brains respond to inputs is a unique function of who we are (genetics + learning)

Question 11

what are the three neuron pathways?

Answer 11

Question 12

what can cause nociception?

Answer 12

• Soft tissue strains/sprains
• Peripheral nerve irritation
• Degeneration
• Lacerations

Question 13

describe nociception vs pain (1 word)

Answer 13

nociception = neural process

pain = experience

Question 14

can nociception alone cause pain?

Answer 14

NO. nociception alone is neither sufficient nor necessary for pain

• phantom limb pain (no nociception, but pain)
• focusing on other things or shock (nociception but no pain)

Question 15

name some influencing factors of pain associated with nociception and some not associated with nociception

Answer 15

Question 16

describe sensitivity to physical activity for those with OA and chronic pain

Answer 16

OA: increased discomfort with longer walking

chronic pain: High SPA = A progressive increase in pain during a standardized physical activity

Question 17

what does sensitivity to physical activity predict?

Answer 17

Question 18

what are the implications for exercise prescription considering sensitivity to physical acivity?

Answer 18

Question 19

order of stability for walking aids?

Answer 19

parallel bars

walkers

axillary crutches

forearm crutches

two canes

one cane

Question 20

what requires higher energy demand, standard or wheeled walkers?

Answer 20

standard

The oxygen demand per meter is increased by 104% and the heart rate per meter by 98

Question 21

what percent of BW does a cane accept?

Answer 21

15%

Question 22

describe the timing of peak force in use of canes

Answer 22

Timing of peak force application may differ depending on functional use

1) Late-stance & toe off – compensate for p-flex

For example, patients with ankle arthroplasty apply peak cane force late in the stance phase suggesting that the cane is use to push forward.

2) early-stance Heel strike – reduce impact force (e.g., hip OA)

Patients with degenerative joint disease of the hip apply peak force early in the stance phase, suggesting that the cane was used for restraint.

Question 23

how to use a cane or 1 crutch

Answer 23

Placing the cane on the ipsilateral side to the leg that needs assistance, increases the torque that the hip abductors need to stabilize the pelvis.

Question 24

how to carry objects using cane (with hip problems, with back problems)

Answer 24

Question 25

how to adjust crutches

Answer 25

Question 26

describe the 3 walkign gaits for assistive devices

Answer 26

Question 27

what percent of people abandon their assistive device after getting it? why?

Answer 27

30-50%

• more than 50% of those people say its difficult and risky to use
• social
• discomfort or pain with device

Question 28

one study said use of mobility aid actually increases fall rick - why?

Answer 28

• Only those with balance impairment, functional decline, and/or falling risk are likely to be using a mobility aid
• May increase risk of falling by causing tripping or by disrupting balance control through other mechanisms (e.g., by competing for attentional resources)
• Walker doesn’t allow for a stepping response
• Have to pick up device and move it

Question 29

what are biomechanical benefits of supportive devices?

Answer 29

• Increases the BOS
• Allow stabilizing reaction forces at the hands
• In contralateral hand – reduces compressive force on hip force by up to 60%

Question 30

what are demands or reverse biomechanical effects of supportive devices?

Answer 30