Lecture test 1 Flashcards
What are the three categories of physical agents? Give examples of each.
1) Thermal (Hot/cold)
2) Mechanical (Traction/ultrasound)
3) Electrical (ES/TENs)
What are the three categories of thermal agents and how deep to each go and examples?
1) Superficial Heating (1-2 cm deep) - Hot pack, fluidotherapy, paraffin
2) Superficial Cooling (1-2 cm deep) - Cold pack, ice massage, vapocooling spray
3) Deep Heating (3-5 cm deep) Microwave, shortwave diathermy, Ultrasound.
What are some benefits of thermotherapy?
Increase circulation
Increase metabolic rate
Increase soft tissue extensibility
Decrease pain (flushes irritants)
What are some benefits of cryotherapy?
Decrease circulation
Decrease metabolic rate
Decrease soft tissue extensibility
Decrease pain (analgesic)
What do mechanical agents do? What are some examples?
(apply force to ↑ or ↓ pressure on the body)
EXAMPLES water traction compression sound
What does water therapy do?
- Applied with or without immersion
- Provides buoyancy, resistance, hydrostatic
pressure, applies pressure to clean wounds - Can transfer heat to and from the area
What does traction do?
- Used to alleviate pressure on structures such as nerves or joints that produce pain or
other sensory changes or that become
inflamed when compressed - Pressure-relieving effects may be temporary
or permanent
What does compression do?
Used to counteract fluid pressure and
control or reverse edema
What does sound (ultrasound) do?
Mechanical form of energy composed of
alternating waves of compression and rarefaction
Thermal and Non-thermal effects
Continuous US
– Heat deep tissue to ↑ circulation, ↑ soft tissue extensibility, ↓ pain
Pulsed US
– Facilitate tissue healing
When would you not use heat?
Acute pain!!
Two categories of electric therapy.
Electromagntic Radiation UV radiation Infared radiation (IR) Laser Shortwave Diathermy (SWD)
Electrical Stimulation NMES TENS IFC HVG
What does UV radiation do?
Produces erythema and tanning of the skin
Does not produce heat
What does infrared radiation (IR) do?
Produces heat only in superficial tissues
What can a laser help with?
Tissue healing
Talk about short wave diathermy
SWD produces heat in both superficial and
deep tissues
PSWD does not produce heat
– Thought to modify cell membrane permeability
and cell function by non-thermal mechanisms
and may control pain and edema
Talk about electrical stimulation
Effects and clinical applications of electrical
currents vary according to the waveform,
intensity, duration, and direction of the current flow and according to the type of tissue to which the current is applied
– Muscle contractions, pain modulation, tissue healing, edema control, iontophoresis
How does the treatment of wounds and TB compare from years ago to today…
Years ago….
IR lamps were commonly used to treat
wounds because it dried out the wound
Sunlight was used to treat tuberculosis
Today….
We know that wounds heal faster when kept
moist
Antibiotics are more effective in treating
tuberculosis
How does the ICF model view function and disability?
- as a complex dynamic interaction between the health
- condition of the individual and the contextual
factors of the environment, as well as personal factors - Applicable to all people
- Neutral to etiology
What is the emphasis of the ICF model?
Emphasis on function rather then condition or
disease
The ICF model reflects what interaction?
the interaction between health conditions and contextual factors as they affect disability and
functioning.
What are health conditions in the ICF model?
diseases, disorders, injuries
What are contextual factors in the ICF model?
environment and personal factors
What are examples of environmental and personal factors in the ICF model?
Social attitudes and structures, legal
structures, terrain, and climate are examples
of environmental factors.
Personal factors are those things that
influence how disability is experienced by a
person, such as gender, age, education,
experience, and character
ICF model is structured around three levels
of functioning:
– The body or a part of the body
– The whole person
– The whole person in a social context
The Role of Physical Agents in
Rehabilitation
– “Without documentation which justifies the necessity of the exclusive use of physical agents/modalities, the use of physical agents/modalities, in the absence of other skilled therapeutic or educational intervention, should not be considered physical therapy.”
What is a contraindication?
Conditions under which a particular treatment should not be applied
What are some contraindications for physical agents?
– Pregnancy (reach fetus)
– Malignancy (alter circulation)
– Pacemaker or other implanted electronic device (alter function, change heart rate)
– Impaired sensation / impaired mentation (not able to report how it feels)
Attributes to consider in the selection of physical modalities
- Goals and effects of treatment
- Contraindications and precautions
- Evidence for physical agent use
- Cost convenience availability
What are the effects of physical modalities?
Inflammation and healing
Pain
Collagen extensibility and motion restrictions
Muscle tone
What is evidence-based practice (EBP) and what is its goal?
is “the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.”
The goal of EBP is to provide the best possible patient care by assessing available research and applying it to each individual patient.
The traditional signs of Life
- Heartbeat
- Body temperature
- Respiration
- Blood pressure
- Levels of consciousness
Four additional measurements
- Pulse oximetry
- Pain scales
- Perceived exertion
- Gait speed
Purpose of Taking Vital Signs
– Establish a database of values for an individual. – Assisting in goal setting and treatment planning. – Assisting with assessment of patient responses to treatment. – Contributing to assessment of effectiveness of treatment activities.
What is a sign vs. a symptom?
Sign
• An observable objective finding related to a person’s condition
• Often able to be quantified by using valid and reliable measurement instruments
Symptom
• How a person experiences a condition
• A subjective finding, often difficult to measure accurately
Pain vital sign or symptom?
Although, not considered a vital sign, indications of pain levels perceived by a patient are usually measured when vital signs are measured.
A baseline measurement of vital signs at rest should be established so that…
…changes in the values as a result of exercise or other factors can be determined.
Particularly important to establish baseline values for the
following type of patients:
- Elderly patients (above 65)
- Very young (under 2)
- Hypertension and following surgery.
What if abnormal resting vital values are found?
You need to find out prior to any activity that could affect vitals. Usually patients with abnormal resting values will be less able to tolerate physical activity or stress producing events.
• Some possible adverse/potentially
dangerous responses to activity are:
Why might these occur in the elderly?
- Mental confusion
- Fatigue
- Exhaustion
- Lethargy
- Syncope (passing out)
- Slow reactions to movements or responses.
- Vertigo
- Excessive diaphoresis (sweating profusely)
- Level of consciousness
Popular cause of dangerous responses in the elderly is dehydration
Contraindications for taking Pulse
No contraindications, except different patients may need to be checked in different places.
Locations for taking Pulse
• Temporal • Carotid Brachial • Radial • Femoral • Popliteal • Dorsalis Pedis • Posterior Tibial • Sites are selected that will not cause discomfort or alter the pulse.
Characteristics of Pulse
- Rate (number of beats per minute)
- Rhythm ( intervals between beats)
- Volume (force)
Normal ranges for pulse
• Pulse – Adult 60-100bpm – Children 80-120bpm – Bradycardia Less than 60 bpm – Tachycardia Greater than 100 bpm
Contraindications for taking Temperature
- Oral: Oral Surgery, youngsters, seizure prone
* Rectal: Surgery, newborns, diarrhea
Normal ranges for Temperature
• Temperature
– Oral 98.6
– Rectal 99.6
– Axillary 97.6
Contraindications for taking respiration
None
Characteristics of Respiration
- Rate (number of breaths per minute)
- Depth (amount of air exchange with each breath)
- Rhythm (regularity of inspiration and expiration)
- Character (any deviation from normal quiet effortless breathing)
Three tissues that suffer irreparable damage if deprived of adequate oxygen for a brief period of time:
– Brain Tissue
– Myocardium
– Kidneys
Define the following • Hypoxia • Eupnea • Tachypnea • Bradypnea • Dyspnea • Apnea
- Hypoxia (lack of oxygen)
- Eupnea (normal breathing)
- Tachypnea (faster than normal)
- Bradypnea (slower than normal)
- Dyspnea (painful or labored)
- Apnea (absence of)
Normal ranges for Respiration
• Respiration
• Adult 12-18 rpm
• Above 20 rpm and below 10 rpb is
considered abnormal
Contraindications for taking Blood
Pressure
• No contraindications (don’t use arm with
shunt)
What is blood pressure - two main points
Blood Pressure
– Pressure exerted by the blood on the walls of
the blood vessels.
– During each contraction blood is pushed into
the blood vessels (systolic pressure).
– Relaxation of the heart between contractions
(diastolic pressure).
Normal Ranges for blood pressure
Normal: 120/80
Pre-hypertension: 120-139/80-89
Stage 1 hypertension: 140-159/90-99
Stage 2 hypertension: At or greater than 160 / At or greater than 100
Many variables influence vital signs
- Pain
- Drugs
- Age
- Sex
- Time of day
- Month
- Exercise
- Weight
- General health status
- Metabolic conditions
- Emotions
The most significant factor in
observation of level of consciousness is
CHANGE
In assessing the mental status of an
individual, you should observe
their movements and responses to their environment, and neurological status.
Define: Lethargic, Confusion, Disorientation
• Lethargic – Slow / sluggish in moving or appears to suffer from abnormal drowsiness. • Confusion – Bewildered / perplexed, and or makes inappropriate answers to questions. • Disoriented – Perceives oneself and or environment incorrectly in relation to time / place.
Define: Delirious, Restless, Stuporous, Coma
Delirious
– Impaired consciousness in area that implies thinking
and behavior, easily agitated and uncooperative.
• Restless
– Extremely sensitive to factors in the environment and
may exaggerate them.
• Stuporous
– Lies quietly in bed and seems to be sleeping, degree
of stupor is determined by the amount of stimuli
required to waken.
• Coma
– Appears to be sleeping, can’t be awakened.
Terms that could describe pain:
- Sharp
- Dull
- Throbbing
- Crushing
- Aching
- Stinging
- Burning
- Deep
- Constant
- Intermittent
Describe the purpose and methods used for the subjective measurement of pain levels perceived by a patient.
Visual Analog Scales (1-10) - important as pain relief is a top priority.
Define pain and talk about its main points
• Defined as an unpleasant sensory and
emotional experience associated with actual or potential tissue damage or described in terms of such damage
• Usually acts as a warning to protect the body from damage
• Most common symptom prompting patients
to seek medical attention
• Many patients with musculoskeletal or Many patients with musculoskeletal or neurological impairments report pain
• Primary goal either control or relief of pain
What are the causes and effects of pain?
EFFECTS
• Alter body structure and function
• Limits participation in home, work, and recreational activities recreational activities
CAUSES
• Generally related to inflammation of musculoskeletal or neurological structures
• Caused by injury, trauma, or degenerative disease
Goals of pain management
• Resolve underlying condition
• Modifying perception of the discomfort Modifying perception of the discomfort
• Maximizing function within the limitations,
whether the source of pain can be modified or
not
• Pain control during recovery is important
• Limiting pain helps the patient fully
participate in rehab
• Reach goals of Reach goals of ↑ activity activity and participation
Types of pain
- Acute
- Chronic
- Referred
Define Acute pain - what does it tell you?
Acute pain warns you that something is….WRONG!
- Short duration, less than 6 months
- Usually demonstrable etiology
- Generally well localized and defined , although its degree of localization varies to some degree with the type of tissue involved
Types of acute pain
• Cutaneous pain
• is usually well-localized and sharp, prickling, or
ting g lin
• Musculoskeletal pain
• is usually poorly localized and is dull, heavy, or
aching
• Visceral pain
• refers superficially and has an aching quality
How does acute pain affect other systems of the body?
• Systemic Level • “fight or flight” • Increased heart rate Increased heart rate • Increased sweating • Expansion of the bronchioles • Dilation of pupils • Shunting of blood from skin and digestive tract to the muscles and brain
Talk about circulation and muscle complications associated with pain
• Compromised circulation is often
inadequate to supply metabolic needs
leading to ischemia, a new source of pain
• Muscle guarding occurs (this reaction of
muscles requires a high level of metabolic
activity at the same time as it compresses
the blood vessels)
Comprised circulation impedes the removal
of the metabolic wastes, many of which
sensitize nocicep, g tors, resulting in further
enhancement of pain
• Edema resulting from injury causes
disruption of the capillaries and lymphatics,
with an increase in capillary permeability as
a result of compression from muscle
guarding
• Further compounds the problems of nutrient
supply and waste removal, causing
additional pain perception and subsequent
muscl di e guarding
• Vicious circle of pain, spasm and pain
• Pain producing substances are released
Define Chronic paint
• Defined as pain that does not resolve in the
usual time it takes for the disorder to heal or
that continues beyond the duration of
noxious stimulation
• Time-based definitions
• Pain lasting longer than 3 or 6 months
• Ongoing condition that is difficult to
manage
What is fibromyalgia?
High concentration of “Substance P” in muscles
How does chronic pain affect the US population?
• Estimated that approximately one third of
the US population has chronic pain
• 14% of US suffers from chronic pain related 14% of US suffers from chronic pain related
to the joints and the musculoskeletal system
How is Chronic pain classified
• May be classified according to pathophysiology
Define and give examples of nociceptive pain
• Nociceptive pain Nociceptive pain is caused by the is caused by the
stimulation of pain receptors by noxious
mechanical, chemical, or thermal stimuli
and associated with ongoing tissue damage
• Arthritis, ischemia, cancer, chronic pancreatitis
Chronic pain
Define and give examples of neuropathic pain
• Neuropathic pain is the result of peripheral
or central nervous system dysfunction
without ongg g oin tissue damage
• Diabetic neuropathy, postherpetic neuralgia,
phantom limb pain
Define and give examples of mixed pain
• Mixed pain syndromes are those with
multiple or uncertain pathophysiology
• Recurrent headaches and some vasculitic Recurrent headaches and some vasculitic
syndromes
Longer the pain persists, the more likely it…
is to be referred away from the site of the
actual cause or lesion.
Mental effects of pain of a very long duration…
anguish, apprehension, depression, or
hopelessness and extends months to years
beyond the recovery period or recurs
intermittently for years.
Physical effects of long term pain…
• Generally inactive for a prolonged period of time.
• Resulting in loss of strength, skill and
endurance and thus progressive disability.
• Frequently receive excessive treatments.
• Can result in drug misuse or abuse.
Sociological effects of long term pain
• Prolonged dependence on others, including
health care practitioners and family
members.
• May show signs of depression.
• Disrupted sleep patterns.
• Altered eating habits and social isolation.
• Pain behavior may also be perpetuated by financial gain.
• Patients with prolonged severe, or very
disabling acute pain have been found to be at increased risk of developg p in chronic pain.
• Pain that lasts longer than 3 months and
leads to a long-term loss of function, as well as imposing many psychosocial stresses on the patient and his or her friends and family.
How is pain transferred from acute to chronic?
• Transition from acute to chronic pain has
not been well defined.
• If pain meets the following three criteria it If pain meets the following three criteria, it
is usually termed chronic pain:
• Cause is uncertain or not correctable
• Medical treatments have been ineffective
• Pain has persisted for longer than 3 months
What is referred pain? How does it work?
- Maybe acute or chronic
- Pain felt at a site in the body elsewhere from the source of disease or injury from the source of disease or injury.
- Referred from one joint to another (hip joint pathology may refer pain to knee).
- Peripheral nerve to a distal area of innervation (compression of spinal nerve).
- Internal organ to an area of musculosketal Internal organ to an area of musculosketaltissue. (angina-upper chest,arm)
- Gallbladder frequently refers pain to the right shoulder or inferior angle of the right scapula.
Why is it important to learn about referred pain?
Important to be aware when treating a neuromusculoskeletal dysfunction, that there is potential for pain referral and be familiar with common pain referral patterns in order to determine the source of a patient’s complaints and select appropriate treatment methods.
Mechanisms of Pain Reception and Transmission
- Pain is generally felt in response to stimulation of peripheral nociceptive structures
- Stimulus is transmitted along peripheral nerves to the CNS
- Reach the cortex and consciousness
Sensation of pain and the response to the sensation are influenced by a variety of factors, which are…
• Physiological mechanisms of the pain receptors
• Anatomy of pain transmitting structures
• Neurotransmitter levels
• Motivation, behavior and physiological and
emotional state of the individual
Variations in any of these factors can alter the individual’s perception of pain severity, type, location and duration
GATE CONTROL THEORY..
• Gate theory briefly states that as nerve
fibers transmit pain impulses through the
sp ,yy inal cord to the brain, they may be altered
or modified presynaptically at any point
along the transmission route from the spinal
cord to the cerebral cortex.
ENDORPHIN THEORY…
• Endorphins/enkephalins (body’s own natural pain relievers) of the nervous system are released in response to the stimulation of the nervous system, particularly via
electrical stimulation.
How do you measure pain?
- Visual analog and numeric scales.
- Comparison with a predefined stimulus
- Semantic differential scales.
What is a semantic differential pain scale?
e.g. - select words that describe your pain. What does your pain feel like?
• Please select the word(s) that best describes your present experience of pain.
Should be used for detailed desciption
What is a visual analog or numeric scale?
Indicate the present level of pain on a drawn line or rate the pain numerically on a scale of 1 to 10
Also could include face scale
Comparison with a Predefined
Stimulus Scale…
Compare the severity of symptoms with the same with the same predefined stimulus, causing rating scales to be more similar
Localized, sensitive area is trigger point. The motor point is where nerve plugs into the muscle.
Tissues with a ______ specific heat require more ______ to achieve the same temperature increase than tissues with a _____ specific heat
High
energy
low
Materials with a ____ specific heat hold more _____ than materials materials with a _____ specific heat when both are at the same temperature.
High
Energy
Low
High specific heat agents (water) are applied at a _____ temperature than air-based thermal agents (fluidotherapy) to transfer the same amount of heat.
Lower
Water stays hotter ______ than paraffin
longer
Skin tolerates a higher _____ heat than _____ heat
Dry, wet
Water _____ than paraffin and maintains______, and paraffin holds _____ than water and _____ quicker
more energy
less energy
less heat
loses its heat
Convection
HEAT TRANSFER BY CIRCULATION OF A MEDIUM OF A DIFFERENT TEMPERATURE. Circulates around body part, such whirlpool and fluidotherapy or even blood circulation.
Conduction
Direct contact such as hot/cold pack or still bath and paraffin
Conversion
Deep treatment, changes from another form. Examples are short-wave diothermy, ultrasound, and metabolism
Radiation
EXCHANGE OF ENERGY DIRECTLY WITHOUT AN INTERVENING MEDIUM. Sun, infrared lamp, radiation heat.
Evaporation
ABSORPTION OF ENERGY AS THE RESULT OF CONVERSIONOF A MATERIAL FROM A LIQUID TO A VAPOR. Vapocoolant spray, sweat
How does Adipose tissue affect thermal treatment?
ACTS AS INSULATION TO UNDERLYING TISSUES, LIMITS THE DEGREE OF TEMPERATURE CHANGE
IN DEEPER TISSUES
How do muscle and blood react to thermal treatments?
•CONTAIN A RELATIVELY HIGH WATER CONTENT, READILY ABSORBS ANDCONDUCTS HEAT.
What do superficial heating agents do and how deep do they go? What are some examples?
PRIMARILY CAUSES ANINCREASE IN SKIN AND SUPERFICIAL SUBCUTANEOUS TISSUE TEMPERATURE.
•1cm‐2cm
- Hot pack
- Cold pack
What do deep heating agents do and how deep do they go? What are some examples?
- INCREASES TEMPERATURE OF DEEPER TISSUES WITHOUT OVERHEATING THE SKIN AND SUBCUTANEOUS TISSUE, (KNEE JOINT, MUSCLE BELLY, ETC)
- 3cm‐5cm
