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Adult Neuro Two > Pain, Tone, and Aerobic Conditioning > Flashcards

Pain, Tone, and Aerobic Conditioning Flashcards

1
Q

nociceptive pain

A

due to activation of nociceptors (inflammation, mechanical irritant, injury)

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2
Q

OA, ankle sprain, RA are all examples of ______ pain

A

nociceptive

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3
Q

nociplastic pain

A
  • due to disturbance in central pain processing
  • increased excitability or decreased inhibition
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4
Q

fibromyalgia, TMD, and non-specific low back pain are all examples of _____ pain

A

nociplastic (central sensitization)

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5
Q

neuropathic pain

A

due to lesion or disease of the somatosensory system

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6
Q

diabetic neuropathy, carpal tunnel, and CRPS are examples of _______ pain

A

neuropathic

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7
Q

T or F: pts with neuro diagnoses can also have nociceptive pain

A

T

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8
Q

while teaching pts about pain, it is important to make pts feel that…

A

they are in control of their pain

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9
Q

what are some green light interventions for neuropathic pain

A
  • antiepileptics
  • exercise
  • sleep hygiene
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10
Q

what is a yellow light intervention for neuropathic pain

A

manual therapy

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11
Q

what are some green light interventions for nociplastic pain

A
  • anticonvulsants
  • antidepressants
  • team based care
  • TENS
  • PNE
  • manual therapy
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12
Q

how to effectively provide PNE

A
  • therapeutic alliance
  • emphasis on function instead of pain
  • don’t use medical terms
  • use “normal”
  • reduce perception of threat
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13
Q

what are some examples of graded motor imagery

A
  • left/right identification
  • visual/motor imagery
  • mirror therapy
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14
Q

T or F: aerobic exercise is indicated for both nociplastic and neuropathic pain

A

T

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15
Q

PNE is particularly important in what kind of pain

A

nociplastic with central sensitization

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16
Q

tone

A
  • resistance of a muscle to passive elongation or stretch
  • residual contraction in resting muscle
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17
Q

tone is influenced by…

A
  • physical inertia
  • mechanical-elastic stiffness
  • tonic stretch reflex
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18
Q

3 categories of tone abnormalities

A

1 - hypertonia
2 - hypotonia
3 - dystonia

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19
Q

hypertonia includes…

A

spasticity and rigidity

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20
Q

what is the difference between rigidity and spasticity

A

rigidity is not dependent on velocity while spasticity is

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21
Q

2 types of rigidity

A

cogwheel and lead pipe

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22
Q

cogwheel rigidity

A

increased tone is released by degrees during passive range of motion so it feels like small, regular jerks

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23
Q

lead pipe rigidity

A

uniform and constant resistance to ROM

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24
Q

decorticate rigidity

A
  • UE flexion, LE extension
  • lesion in diencephalon
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25
decerebrate rigidity
- UE and LE extension - lesion in brainstem
26
dystonia
- prolonged involuntary movement disorder - twisting/writhing movement - injury of basal ganglia
27
what are 2 tone intensity measures
- modified ashworth scale - tardieu scale
28
modified ashworth scale
0 = No increase in muscle tone 1 = Slight increase in muscle tone, manifested by a catch and release or by minimal resistance at the end of the range of motion when the affected part(s) is moved in flexion or extension 1+ = Slight increase in muscle tone, manifested by a catch, followed by minimal resistance throughout the remainder (less than half) of the ROM 2 = More marked increase in muscle tone through most of the ROM, but affected part(s) easily moved 3 = Considerable increase in muscle tone, passive movement difficult 4 = Affected part(s) rigid in flexion or extension
29
this is a biomechanical method of assessing muscle tone
wartenberg pendulum test
30
how do you measure spasticity of the quadriceps with wartenberg pendulum test
place pt in supine and use gravity to provoke stretch reflex. reduction of swing is indicative of spasticity
31
If H reflexes are recordable at rest in muscles that aren't normally obtainable at rest what does that pt likely have?
hyperreflexia
32
what are greenlight interventions for improving tone
- BoNT - selective dorsal rhizotomy - intrathecal baclofen - diazepam
33
how does botox work to decrease tone
- prevents the release of ach into NMJ relieving focal hypertonia - degrades protein 25 which is required for ACh to presynaptic membrane
34
what are advantages of botox injections
- selectivity - greater intensity of effect - reversibility - avoidance of systemic side effects
35
what are disadvantages of botox injections
- pain - impractical for large muscles - anatomic inaccessibility of some muscles
36
intrathecal baclofen pump
- liquid baclofen is administered directly into subarachnoid space - drug is delivered via implantable pump
37
T or F: baclofen pumps have a lot of systemic side effects. why or why not
F: because it is not circulating in the blood stream
38
dorsal root rhizotomy
- dorsal cord and grey matter is cut from L2-S2 level
39
what does dorsal root rhizotomies allow the body to avoid
excess sensory input
40
dorsal root rhizotomies are performed on children with...
spastic diplegia
41
what are some oral meds for tone?
- baclofen - benzodiazepines - tizanidine - clonidine - dentrolene
42
oral meds are a _____ light intervention for tone
yellow
43
how do oral meds for tone work? (2 main mechanisms)
- compensate for reduced GABA or other inhibitory neurot. in the brain or spinal cord - reduce the amount of excitatory neurot through inhibition
44
these 3 drugs compensate for reduced GABA to reduce spasticity
- baclofen - benzodiazepines - gabapentin
45
these 2 drugs reduce spasticity by increasing inhibition (alpha 2 system)
- clonidine - tizanidine
46
what is the most widely used oral anti-spasticity drug
- baclofen (BAGA-B receptor agonist)
47
what do benzodiazepines do
increase presynaptic inhibition
48
this is the only anti-spasticity drug approved by the FDA that acts peripherally
dantrolene
49
dantrolene acts directly on?
muscles - uncouples excitation and contraction by inhibiting calcium release from SR
50
phenol block
- produced demyelination, destruction of axones, and an immediate decrease in spasticity
51
deep brain stimulation
- implantation of electrodes in the brain - stimulation of a small area results in network-wise changes
52
deep brain stim is most commonly used in what disease
parkinson's
53
transcranial direct current stimulation
works by applying a direct current to the brain, usually transmitted by surface electrodes *evidence not very strong
54
T or F: aerobic conditioning can enhance brain function and improve motor learning
T
55
green light interventions for improving aerobic capacity
- treadmill - ergometry - recumbent stepper - cycling - water aerobics - circuit training
56
yellow light interventions for improving aerobic capacity in an acute phase
FES induced cycling and walking
57
intensity of aerobic conditioning
moderate - 40-70% of VO2 max 11-14 RPE
58
frequency/duration of aerobic conditioning
3-5 days/week for 20-60 mins can be broken down into multiple 10 minute sessions
59
you can usually start mobilizing ____ hours after stroke
24
60
in acute/subacute phases keep RPE at ______ or less
11 HR 10-20 above resting
61
T or F: it is okay if your pt performs a valsalva maneuver
F
62
warning signs to stop exercise
- lightheadedness or dizziness - chest heaviness, pain, tightness, angina - palpitations or irregular heart beat - sudden SOB not due to increased activity - volitional fatigue/exhaustion
63
cardiovascular dysautonomia is common in what condition
MS
64
aerobic priming
- acute exercises stimulate brain region involved in motor and cognitive processes - improve memory, processing speed, executive functioning, and motor skill learning

Adult Neuro Two (15 decks)

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