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Passive Care > Stages of Healing Ch.1 > Flashcards

Stages of Healing Ch.1 Flashcards

1
Q

What are the 4 stages of healing?

A
  1. ) Hemostasis
  2. ) Inflammatory
  3. ) Proliferation (repair)
  4. ) Remodeling/maturation
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2
Q

Hemostasis involves what and lasts how long?

A

Initial blood clotting to stop bleeding. Lasts seconds -> minutes.

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3
Q

What is another name for the inflammatory stage, and how long does it last?

A

The acute phase.

Hours -> days -> weeks

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4
Q

How long is the proliferation phase?

A

Weeks -> months

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5
Q

How long is the maturation phase?

A

Months -> year

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6
Q

Does the cause of injury change the stages of the healing process? Are there any exceptions?

A

No. Time can vary

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7
Q

Are the stages of healing clearly demarcated and occur separately?

A

No, there is much overlap.

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8
Q

What is the purpose of the Inflammation (acute) phase?

A

To defend against foreign intruders (infection), Remove damaged tissue and debris, Immobilize area.

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9
Q

How well will avascular or poorly vascularized tissue heal?

A

Not well

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10
Q

What are the signs of Inflammation?

A 
Rubor - redness
Calor - heat
Dolor - pain
Tumor - swelling
Functio laesa - loss of function
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11
Q

What characterizes the inflammation stage at the site of injury?

A

Vasodilation, Increased capillary permeability, Phagocytosis by neutrophils and macrophages.

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12
Q

Which inflammatory chemicals cause pain?

A

Bradykinin, prostaglandins, serotonin

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13
Q

Inflammation can cause secondary injury. What are the 2 types of secondary injury?

A

Secondary enzymatic injury, secondary hypoxic injury.

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14
Q

What characterizes secondary enzymatic injury?

A

Lysosomal enzymes released
Not specific
Healthy tissue is damaged

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15
Q

What characterizes secondary hypoxic injury?

A

Hemorrhage, edema, clotting, spasm, hematoma.
These lead to decreased O2 and nutrients.
Damage to surrounding uninjured tissue.

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16
Q

What are the doctor’s goals and intervention in the acute phase?

A

Goals: limit extent of inflammation, preserve ROM

Intervention: PRICE (protect, rest, ice, compress, elevate).

17
Q

What is the time frame for the acute phase of an ankle sprain with each grade?

A

Grade 1: 1-3 days

Grade 2: 2-4 days

Grade 3: 3-7 days

18
Q

What is the Doctor’s focus during the acute phase of an ankle sprain?

A

Decrease swelling
Decrease pain
Protect from re-injury
Maintain appropriate weight bearing

19
Q

What are the protective measures needed for the acute phase of an ankle sprain?

A 
Taping
Functional bracing
Remove cast or walking boot
Rest
Crutches
20
Q

What are the interventions needed for the acute phase of an ankle sprain?

A

Ice (to decrease pain and swelling)
Compression
Elevation (above heart, add in ankle pumps - dorsi/plantar flexion)

21
Q

What characterizes the proliferative (repair) stage at the site of injury?

A

Angiogenesis (new capillaries)
Fibroblasts, chondroblasts, Osteoblasts
Extracellular matrix (type III collagen, Proteoglycans)
Proprioception

22
Q

What is the timing of the proliferation phase by grade?

A

Grade 1: 2-4 days
Grade 2: 3-5 days
Grade 3: 4-8 days

23
Q

What are the doctor’s goals for the proliferation phase?

A 
Decrease pain
Decrease swelling (if still present)
Encourage and increase proliferation
Increase pain free range of motion
Begin non-weight bearing proprioceptive training
Provide protective support as needed.
24
Q

What kind of passive care interventions are appropriate for the proliferation phase?

A

Decrease pain and swelling: IFC, PreMod, Hi-Volt, Ice, Contrast baths, Massage (gentle)
Soft orthotics

Administer EPA’s to increase proliferation: Thermotherapy, ultrasound, low level laser therapy, microcurrent.

25
Q

What are the active care interventions appropriate for the proliferation phase?

A

Increase weight bearing (as pain permits). Partial to full weight bearing progression).

Active range of motion: (can be performed in water). Plantar/dorsiflexion, foot circles, alphabet.

Proprioceptive training, progressing to unstable surface: Seated (less of a challenge), standing (more challenge/risk), wobble boards, dynadiscs.

Strength exercises (to limit atrophy): isometrics in a pain free range. toe curls with towel, pick up objects with toes.

Stretching: Passive ROM (dorsi/plantarflexion as pain allows), achilles stretching, joint mobilization.

26
Q

What characterizes the remodeling/maturation phase?

A 
Scar contraction (can lead to joint adhesion, loss of motion).
Decrease of blood vessels.
Type III collagen replaced by type I (collagen aligns across stress lines). 
Cross linking continues.
27
Q

Tension on connective tissue causes:

A

Increased collagen fibril diameter
Increased cross linking
Increased number of collagen fibrils
Increased collagen fibril packing density

28
Q

What is beneficial about collagen fibers aligned in an organized, parallel fashion?

A

Forms the greatest number of cross links. Possesses optimal strength.

29
Q

What is the timing associated with the remodeling phase of an ankle sprain by grade?

A

Grade 1: 1 week
Grade 2: 2 weeks
Grade 3: 3 weeks

30
Q

What are the goals of the remodeling phase of an ankle sprain?

A 
Increase pain-free ROM
Progress proprioceptive training
Regain full strength
Normal biomechanics
Protect and strengthen any residual joint instability
31
Q

What are the active care interventions for the remodeling phase of an ankle sprain?

A

Stretching: (gastroc/soleus) Joint mobilization.

Strengthening: heel toe raises (controlled), stair steps, quarter squats, eccentric/concentric with weight cuffs.

Proprioceptive training: progress to single leg exercises.

32
Q

What are some task specific skills appropriate for active care in the remodeling phase?

A

Running, alternating jogging to sprinting in a straight line, agility training, proprioception (e.g. multi-directional lunges)
Power: plyometrics, box jumps, etc.

33
Q

Properly applied external forces enhance what?

A

Collagen organization (arrangement).

Passive Care (12 decks)

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