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Anesthesia 2 > Rehab 1 > Flashcards

Rehab 1 Flashcards

1
Q

Rehab

A

The use of noninvasive techniques to return non human animals to functional activity after injury

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2
Q

Components of rehab

A

-application of heat and cold
-ultrasound
-electrical stimulation
-low level lasers
-stretching, massage, therapeutic exercises, aquatic therapy

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3
Q

Physiotherapy

A

-cannot use this term because it is reserved for licensed physiotherapists

Need to use REHABILITATION
*chiropractic and acupuncture are separate

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4
Q

Old ways vs. new ways

A

-Old: cage rest

-New: rehab such as underwater treadmill shortly after surgery

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5
Q

Disuse and immobilization

A

-immobilization may still be needed for some animals depending on procedure

-some animals may need split

-some animals will just avoid using it

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6
Q

Cartilage

A

-avascular, aneural, chondrocytes, ECM

-nutrition is through diffusion in synovial fluid

-proteoglycans are hydrophilic resulting in turgidity of cartilage

-cartilage is strongest when stiff

-loss of proteoglycans and water results in softening

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7
Q

Immobilization impact on cartilage

A

-decreased synovial fluid production and diffusion of nutrients

-decrease in chondrocytes and ECM

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8
Q

Splinted in extension vs flexion (impacts on cartilage)

A

-if splinted in flexion, reversible thinning of cartilage

-if splinted in extension, irreversible changes similar to OA
*erosion of cartilage, osteophyte production

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9
Q

Factors affecting changes due to immobilization

A

-age (young growing dogs have most pronounced changes)
-How rigid the fixation is
(External fixator>cast>splint)
*amount of motion in the splint will reduce cartilage damage

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10
Q

Response of muscle to disuse

A

-Rapid atrophy and loss of strength

-weight bearing is critical to maintain muscle mass

-it takes at least 2x as long to regain muscle as the immobilization time

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11
Q

Muscle type I fibers

A

-slow twitch
-more susceptible to atrophy due to immobilization
-found in large numbers in postural muscles (eg. quads)

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12
Q

Type II muscle fibers

A

-fast fibers
-less susceptible to effects of mobilization

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13
Q

Tendon and ligament changes from immobilization

A

-rapidly lose strength when splinted

-passive range of motion without weight bearing helps increase tensile strength and realign fibers

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14
Q

What point is the most concerning point for tendon and ligaments?

A

-insertion point of tendon/ligament on the bone

-after a year, remobilization tendons and ligaments are still not at full strength

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15
Q

Bone impacts from immobilization

A

-production of bone will decrease but resorption continues at normal or increased rate

-bone loss is more pronounced in the distal limb

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16
Q

Where is bone loss worse?

A

Worse in the trabecular (spongy) bone rather than cortical bone

Immature dogs lost bone faster but also regain it faster once using the limb

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17
Q

Summary effects from a splint

A
  1. cartilage- thinning, possible erosion
  2. Muscle- atrophy and reduced strength of splinted limb
  3. Tendon- rapid decrease of strength= floppy foot
  4. Bone- fracture healed, bone atrophy especially distal bones
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18
Q

Goals of Rehab

A

1.reduce pain and inflammation early on

  1. minimize changes from disuse and immobilization
  2. Return patient to normal or as normal as possible
  3. Early controlled use of injured area faciliated and speeds healing of bone, muscle, tendon and improves function
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19
Q

Myofascial pain

A

A regional pain syndrome characterized by myofascial trigger points in palpable taut bands of skeletal muscle that refer pain to a distance

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20
Q

Myofascial trigger points

A

-dense, hyperirritable areas within a taut band of muscle
-painful on palpation and pain may radiate
-electrical activity similar to areas of muscle cramping

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21
Q

Effects of myofascial trigger points

A

-significant source of pain
-can contribute to central sensitization
-associated with motor dysfunction
-reduce athletic performance

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22
Q

Treatment of myofascial trigger points

A

-acupuncture
-massage
-laser
-therapeutic ultrasound

23
Q

Cryotherapy

A

-used during acute inflammatory phase (first 5 days)

-decreases swelling, activity of inflammatory factors and tissue metabolisms

24
Q

Mechanism of cryotherapy

A

provides analgesia by reducing nerve conduction velocity and decreasing the activation of A-delta fibers and C fibers

25
Q

Game-Ready

A

-circulating cold water through inflatable cuff
-will never go below 0C so no frostbite

26
Q

Cold contraindications

A

-vascular disease
-altered sensation (from paralysis because they cannot tell you its too cold)
-areas of previous frostbite
-open wounds
-exposed superficial nerves

27
Q

Heat

A

-used in subacute and chronic inflammatory phases (after day 5)

28
Q

What does use of heat do?

A

-relax muscles
-increase bloodflow to muscles
-increase venous and lymphatic drainage
-increase flexibility of superficial tissues before stretching

29
Q

Mechanism of using heat for reducing pain

A

-increase bloodflow to ischemic areas and reduce muscle spasms

-stimulation of cutaneous thermal receptors, which decreases pain transmission to the brain at the level of the dorsal horn in the spinal cord

30
Q

Heat contraindications

A

-vascular disease
-decreased sensation
-obtunded patient
-over a tumour
-over a pregnant uterus
-acute inflammation (first 5 days)
-infection

31
Q

Therapeutic ultrasound

A

Application of sound waves at higher frequencies than can be heard
-can reach up to 5cm deep
-can choose heating or non heating settings (both speed tissue healing)

32
Q

Heating settings of therapeutic ultrasound

A

-cause deep heating of tissues to reduce muscle spasms and adhesions
-in chronic conditions the promotion of an inflammatory response is thought to speed healing process
-heating settings should not be used in acute inflammation

33
Q

Indications for ultrasound

A

-improve joint mobility
-improve tendon and bone healing
-reduce scar tissue, adhesions, muscle spasms
-treat calcified tendons

34
Q

Electrical stimulation

A

2 types:

  1. Transcutaneous electrical neuromuscular stimulation (TENS)= analgesia
  2. Neuromuscular electrical stimulation (NMES)= used for strengthening
35
Q

TENS

A

-stimulates endorphin release
-blocks transmission of pain impulses through dorsal horn of spinal cord
-improves blood flow and decreases muscle spasms
-helps reduce edema

36
Q

NMES

A

-Stimulates muscle contraction
-used early in postop period to strengthen muscles, prevent muscle atrophy and improve joint motion
-also beneficial for enhancing circulation and reducing edema

37
Q

NMES and exercise

A

Not an effective exercise in strengthening muscles or preventing atrophy

-useful in patients that cannot bear weight and in neurological conditions where animals do not have motor function

38
Q

Low level laser

A

-Also called cold laser, therapy laser, photobiomodulation

-laser light photons absorbed by mitochondria and increase ATP production

-Also see increase in nucleic acid synthesis, cell division and fibroblast proliferation

39
Q

Low level laser analgesia mechanisms

A

-modulate tissue levels of NO and prostaglandins

-anti inflammatory effects

-neural mechanisms that alter nerve conduction velocities

-increased release of endogenous endorphins

40
Q

Laser uses in animals

A

-lick granulomas
-self trauma
-superficial skin irritation
-supposed to work well for feather picking in birds
-some evidence for OA

-intervertebral disk disease
-releasing tight muscles or trigger points
-otitis externa
-cystitis
-superficial pyoderma

41
Q

Shockwave

A

-application of high velocity and high pressure sound waves
-promotes tissue healing and analgesia

42
Q

2 types of shockwave

A
  1. Focused: increased depth of penetration, requires sedation or anesthesia
  2. Radial- equal effectiveness to focused for superficial structures, no sedation required
43
Q

Shockwave for tissue healing

A
  1. Tension and compression within the tissues result incavitation bubbles within the tissue
  2. collapse of bubbles results in release of energy, release of free radicals, increased membrane permeability
  3. Can stimulate faster healing of soft tissues and non union fractures
44
Q

Shockwave for analgesia

A

-mechanisms poorly understood
Could be:
-overloading nociceptors
-cell damage that prevents membrane potentials for transmission of pain
-increase in anti inflammatory cytokines

45
Q

Typical treatment of shockwave

A

-once a week for 3 treatments
-effects often last several months

46
Q

When is shockwave used in dogs

A

-OA
-chronic tendinopathies
-non union fractures

47
Q

Aquatic therapy relative density

A

Ratio of weight of object to weight of equal volume of water

Water=1
Fat=0.8
Muscle=1
Bone=1.5-2

=Lean is 1.1, obese=0.93
*obese float, lean sink

48
Q

Aquatic therapy buoyancy

A

The upward thrust of water on a body that creates an apparent decrease in weight

49
Q

Hydrostatic therapy

A

Fluid pressure exerted on all surfaces of an immersed body, depends on depth and density of fluid
*can help reduce edema

50
Q

Viscosity

A

Frictional resistance caused by cohesive/attractive forses between molecules of a liquid
*moving through water is harder than moving through air

51
Q

Surface tension

A

Water molecules have greater tendency to adhere to each other at the surface of the water
-more difficult to move in and out of the water, than to move fully immersed through it

52
Q

Treadmill vs. swimming

A

Extension=walking
Flexion=swimming

53
Q

Underwater treadmill

A

-allows for controlled return to exercise post surgery
(can start once skin sutures removed)

-helps improve range of motion and mobility

-promotes weight loss

54
Q

Aquatic therapy contraindications

A

-open wounds or infection
-skin sutures
-external fixator/cast/splint
-unstable repair
-cardiovascular or respiratory difficulties (caution with brachycephalics)
-caution with epileptics

Anesthesia 2 (17 decks)

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