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Passive Care > Pain, neuromuscular control, and biofeedback > Flashcards

Pain, neuromuscular control, and biofeedback Flashcards

1
Q

What are the categories of pain?

A 
• Acute pain vs Chronic pain
– Don’t forget to look for the yellow flags
• Nociceptive
– Somatic or visceral
• Neuropathic
– Peripheral or Central
• Psychogenic
• Carcinogenic
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2
Q

What is Kubler-Ross’s death and dying model?

A

– 5 stages of response to terminal illness
– Denial, anger, bargaining, depression,
acceptance

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3
Q

T/F

Kuber-Ross’s death and dying model is applicable to athletic injury

A

False

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4
Q

What are cognitive-appraisal models of injury

A

• Models state that response to injury
depends on understanding of the injury
• Response to injury is not neatly divided
into stages in particular order
• Response to injury can be influenced by
the actions and message of the doctor!!!

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5
Q

T/F

When assessing a patient you need to be blunt with what you say to the patient, telling them exactly how it is regardless of what the patient might insinuate. Injuries are just physical anyways.

A

False

Patients often hear different things that what you say, must be aware of this.
Must also be aware of the psychological/emotional aspect to injuries.

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6
Q

Examples of telling patients of their injuries the wrong way:

A

“Your meniscus is shot”
“You blew out your knee”
“Severe degeneration with disc disease”
“You have the bones of 60 year old man”`

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7
Q

What is FAKTR?

A

Functional and kinetic treatment with rehab

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8
Q

What are some of the primary characteristics of A-beta fibers?

A

Touch, pressure, hair deflection
Myelinated
Large diameter
Low threshold

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9
Q

What are the basic characteristics of A-delta fibers

A

– Warm and cold receptors, hair follicles, free
nerve endings
• Touch, pressure, temperature and pain
• Free nerve endings respond to noxious stimuli
such as pricking, pinching and crushing
– Myelinated
– Smaller diameter than A-beta (1-6 micrometers)
» Slower conduction velocity

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10
Q

What are the basic characteristics of C fibers?

A

– Pain, touch, pressure, temperature
• Include efferent postganglionic fibers of
sympathetic nervous system, mechanoreceptors,
nociceptors and thermoreceptors
• Smallest peripheral nerves associated with pain
– Unmeylinated
– Small diameter (less then one micrometer)
» Slow conduction velocit

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11
Q

What are the most important parts of the thalamus for pain reception?

A

VPL (ascending fibers from the head synapse) and VPM (fibers from the head and face synapse)

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12
Q

After VPL/VPM where does the pain signal go?

A

Somatosensory cortex then limbic system

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13
Q

What is modulation phase?

A

• Any activity after the cortex has received input
• Have an excitatory or inhibitory role on new
impulses
• Hypothalamus

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14
Q

In peripheral pain modulation what does ice do?

A

– Decrease the effects of chemical mediators

– Decrease speed of pain transmission

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15
Q

What is gate theory?

A

– Non-painful stimulus can block the transmission of
noxious stimulus
– Substantia Gelatinosa in dorsal horn of spinal cord
acts as a “switch operator”.
– Interneuron that utilizes enkephalin is present in
substantia gelatinosa
– Inhibits pain transmission within the dorsal horn

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16
Q

What is motor TENS?

A

– Low frequency, high intensity stimulation of
peripheral nerves

Causes activation of Reticular Formation and
pituitary gland

17
Q

DEOS

A

Descending endogenous opiate system

18
Q

What are the components of noxious pain modulation?

A

– Electrical stimulation of C fibers in the injury
area (Noxious TENS)
– Activates the Periaqueductal Gray (PAG) and
the Raphe nucleus
– Serotonin neurons in the dorsal horn inhibit
the second order neuron either directly or
through an interneuron
– Also with ice stimulation of C fibers during
burning and aching sensation

19
Q

What is nerve block pain modulation?

A

• When stimulation encroaches on the
refractory period of the sensory nerve and
causes inhibition

20
Q

What is nerve block pain modulation called and what are it’s results?

A

Called Wedenski’s inhibition or action
potential failure and results in anesthesia
between the electrodes

21
Q

What 2 EPA’s are best at achieving nerve block pain modulation?

A

Russian current, Interferential current

22
Q

What is EIH

A

Exercise induced hypalgesia. Decreased pain sensation during activity because of the activation of DEOS and catecholamines (must consider this if treating an athlete who just came off the field, may not feel the extent of the injury ‘cause all jacked up).

23
Q

Neuromuscular control consists of 3 components, all of which must be addressed in a rehabilitation plan, what are they?

A

– Consciously controlled muscle contraction (for loss of contraction ability due to injury)
– Reflex responses (e.g. ankle reflex to resist eversion)
– Complex movement patterns (injury leads to loss of these unconscious learned patterns)
• or complex functional movements

24
Q

What does a complex movement pattern refer to?

A

Unconscious movement patterns that are “second nature” after much practice.

25
Q

What are the three aspects of injury that disrupt complex movement patterns

A

– Swelling
– Pain
– Altered nervous system
input (afference)

26
Q

T/F

Pain can alter movement patterns (even in
absence of swelling)

A

True

27
Q

How does pain effect motor control?

A

When active exercise is painful the motor
patterns change which perpetuates
abnormal motor control and slows
recovery possibly leading to further injury

28
Q

What aspects of altered nervous system input have been shown to be affected with injury?

A 
– Balance
– Protective Reflexes
– Force output
– Joint stability
– Position sense
29
Q

What are 4 clinical things you can do to restore neuromuscular control?

A 
• Active Rehabilitation
• EPAs to permit pain free exercises
• Neuromuscular electrical stimulation for
muscle activation
• EMG biofeedback for retraining
30
Q

What is biofeedback?

A

• The use of information to bring
physiological events to conscious
awareness in the patient (e.g. mirror, video tape, clinicial, patient, electromyography).

Measuring stress is one way to do this.

31
Q

What is electromyographic feedback?

A 
• Teaching aid
• Electrical activity in the muscles detected
– Visual or auditory feedback
• Relearning motor patterns and motor
control
• Relaxation of muscle spasm and muscle
guarding
32
Q

Where are needle electrodes placed?

A

Over specific portion of muscle

33
Q

Where are surface electrodes placed?

A

Over whole muscles or muscle groups

34
Q

What are the clinical applications for electromyographic feedback?

A
  • EMG provides positive feedback
  • Helps reduce trial and error
  • Helps reduce patient frustration
35
Q

If you are unable to generate any muscle contraction with EMG, what are 2 things you can do?

A

– Tap or stroke the muscle

– Neuromuscular stimulation (Russian stim)

36
Q

What is functional progression?

A 
• Adjusting, EPAs, Active Care
• Reduce pain and prevent/minimize
adaptations
• Early restoration of neuromuscular control
starts with single muscles but must
progress to specific activities
– Rehab/Active Care

Passive Care (12 decks)

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