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cp3 > test > Flashcards

test Flashcards

1
Q

case management usually used with pts w/

A

high cost conditions

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2
Q

case mngmt is used to provide pts with

A

resources to assist

achieve cost effective outcomes

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3
Q

case manager is usually

A

nurse or social worker

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4
Q

pts that likely have a case mangager

A

work related injuries

in the hospital

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5
Q

PT w/ case mangagers

A

communicate status and needs of pt

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6
Q

when do D/c plans begin

A

day one

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7
Q

where is D/c documented

A

POC

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8
Q

Episode of care

A

D/c / discontinuation of intervention

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9
Q

criteria for conclusion of care

A

achievement of goals/achievement of optimal level of function
Lack of progress/No longer requires skilled care

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10
Q

components of episode of care

A

current physical or functional status

justification for termination of PT

degree of goals met

plans related to pts continuing of care

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11
Q

prognosis

A

the predicted optimal level of improvement in function and amount of time needed to reach that level

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12
Q

prognosis is crucial in the development of

A

the POC

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13
Q

for prognosis you must make an explicit statement of

A

excellent, good, fair, poor regarding their prognosis and rehab potential

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14
Q

prognosis should be documented in

A

assessment or POC

not in both

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15
Q

proposed duration and frequency mean what

A 
Frequency= how often you will provide PT services
Duration= anticipated length of the episode of care
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16
Q

progress in
daily note
progress note
reexam

A

daily - brief summary
progress note - more detailed
reexam - most detailed form of summary

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17
Q

assessment of pt response to tx must occur

A

at every pt encounter

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18
Q

alterations of POC need to occur with

A 
pt change of status
example: 
function has diminished
function has not changed
function has improved
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19
Q

reexamination components

A

clinical impression or diagnosis
obj reassessment of test, measure and OMs
goal status
eval

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20
Q

document goals met by a

A

percentage

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21
Q

surgical protocols are based on

A

tissue healing properties
vary from surgeon to surgeon
protocol serves as a guideline

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22
Q

pt edu

A

is vital post op

provide written resources

edu on rehab progression, contr/precautions and HEP

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23
Q

appropriate to prepare a _____ with a pt to surgical follow up appointments

A

progress note

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24
Q

goal of IASTM

A

remove scar tissue

stim tendons and muscle to return to normal function

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25
Q

IASTM increases ___

A

blood and nutrient supply to the injured area

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26
Q

IASTM also helps synthesize

A

new collagen and realign them

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27
Q

IASTM proposed mechanism scar

A

Inflammation restarts the healing process by reducing the scar tissue and releasing adhesions

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28
Q

pain is caused by

A

Pain is caused by inflammation, when an injured tissue becomes inflamed, immune cells are recruited and phagocytosis occurs

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29
Q

ROM IASTM proposed mech

A

IASTM improves the extensibility of soft tissues by treating their restrictions/adhesions

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30
Q

alternative ROM proposed mech IASTM

A

Stimulating the mechanoreceptors alters the proprioceptive input sent to the central nervous system, which in turn changes the tension in tissue-related motor units

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31
Q

dosage and angle for IASTM

A

20-120s

30-60angle

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32
Q

side effects for IASTM

A

bruising
petechia
soreness

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33
Q

relative contra IASTM

A 
Cancer
Kidney dysfunction
Pregnancy
Rheumatoid arthritis
Varicose veins
Osteoporosis
Lymphedema
Fracture
Chronic regional pain syndrome
Use of certain medications (e.g., anticoagulants, steroids, or nonsteroidal anti-inflammatory drugs)
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34
Q

absolute contra IASTM

A 
Open wound
Unhealed suture sites
Thrombophlebitis
Uncontrolled hypertension
Skin infection
Hematoma
Myositis ossificans
Unstable fractures
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35
Q

dry needling used to tx

A

muscles, ligaments, tendons, subcutaneous fascia, scar tissue

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36
Q

dry needling produces a ___ and _____

A

local and central nervous response to restore homeostasis

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37
Q

deep dry needling

A

Deep dry needling: needle is pierced deep into the muscle/target tissue. Local twitch response often elicited

38
Q

superficial dry needling

A

Superficial dry needling: only the skin overlying the target tissue is pierced

39
Q

needling manipulation

A

Needle manipulation: winding or pistoning of needle in treatment area

40
Q

intramuscular E-stim

A

Intramuscular electrical stimulation: e-stim applied with needle in treatment area

41
Q

proposed mechanism dry needling
1. about winding

  1. pain modulation
  2. pain modulation
A

Langevin researched cell stress via winding of needles which lead to remodeling cyto-architecture, protein synthesis, and virtually micro healing

Opioid-formation from various cells can be stimulated by dry needling (immune cells, keratinocytes, fibroblasts).

A-delta pain to reverse changes via C-fiber pain (gate control)

42
Q

acupuncture vs dryneedling

A

acupuncture - Targets specific “meridians” on the body

dry needling - Targets specific muscle/structure thought to be involved in impairment and pain

43
Q

Kinesiotape stretch at ends

A

0%

44
Q

KT tape does direction of pull matter

A

Yes

for rounded shoulders you would want to pull in the direction of the recoil of the tape

45
Q

indication for KT tape

A 
Indications
Swelling/edema
Pain
Proprioceptive feedback
Muscle activation/deactivation (disputable)
46
Q

contra for KT tape

A

Contraindications
Open Wounds
Skin lesions
Adhesive allergies

47
Q

length KT can be worn

A

3-5 days

48
Q

how to activate glue

A

rubbing = heat

49
Q

how long for glue to be at full strength

A

20-30 mins

50
Q

easier to pull off tape when

A

it is wet

51
Q

fan strip is used for (KT tape)

A

edema

52
Q

psychosocial consideration for individuals w/ chronic pain

A

Likely have seen several medical practitioners by the time they get to you
Likely have had at least 1 negative encounter with a medical practitioner
There pain/condition may have been discounted by someone they have encountered
Common that they may have heard several different explanations for their pain, resulting in confusion
Common that these individuals feel a sense of desperation

53
Q

approach for PNE should take the

A

individuals pain experience and complexity into consideration

54
Q

you want to find out PNE

A

their perception of their own problem

55
Q

OMs for fear

A

Fear Avoidance Belief Questionnaire
Pain Catastrophization Scale
Tampa Scale for Kinesiophobia

56
Q

function OMs

A

ODI, NDI, DASH, LEFS, FAAM,

57
Q

OMs used to (PNE)

A

measure progress

58
Q

FABQ w vs FABQpa

A 
FABQ w
Total Possible Points: 42
High Score>34
FABQpa
Total Possible Points: 24
High Score >14
59
Q

PCS - pain catastrophizing scale

A 
3 distinct dimensions
Rumination
Magnification
Helplessness
Score of greater than or equal to 30 indicates clinically relevant level of catastrophizing
60
Q

tampa scale for kinesiophobia

A

Score ≥ 37 indicates that patient likely has fear of movement

61
Q

red flag for PNE

A

Looking for patterns to suggest viscerogenic or systemic origin

Immediate attention

62
Q

Yellow flag PNE

A

Psychosocial barriers to recovery

increase risk of LT disability

63
Q

Patient health questionnaire

PHQ-2
vs
PHQ-9

A

PHQ-2 Score ≥ 2 should be further evaluated with PHQ-9

PHQ-9 Score ≥ 10 indicates depression

64
Q

state trait anxiety inventory

A

self eval Q

score >39-40 indicates clinically significant symptoms of anxiety
Older adults Score of ≥ 54-55

65
Q

Physical exam of PNE

A

global, functional movements

enhancing the therapeutic relationship

Include testing for sensitive nervous system if appropriate

May even introduce PNE at this time

66
Q

Assessing Pain Mechanisms

A

Pain neuromatrix
Widespread brain activity associated with pain experience
They way we assess pain can ignite the pain neuromatrix

67
Q

use the word____. sparingly with PNE

A

pain

68
Q

CS criteria

A

Perceived pain/disability disproportionate to nature of injury/pathology AND
Diffuse/neuro-anatomically illogical distribution OR hypersensitivity present

69
Q

widespread pain index

A

May utilize the Widespread Pain Index
Maps pain locations
Includes 19 body regions
Score of 7 or greater suggestive of widespread pain

70
Q

Central Sensitization Inventory (CSI)

A

Central Sensitization Inventory (CSI)

Cutoff score of 40 indicates possibility of predominant CS pain

71
Q

chronic pain inventory conventional rehab is often

A

unsuccessful

72
Q

fear avoidance model for PNE

A

injury –> pain experience –> then they associate pain with fear

73
Q

PNE aims to

A

PNE aims to explain to patients the biological and physiological processes involved in a pain experience and, more importantly, defocus the issues associated with the anatomical structures.”

74
Q

what kind of evidence for PNE

A

Strong evidence

All studies 6/10 or higher on PEDro scale

75
Q

pt edu with pNE

A

Avoid using terminology that increases fear and anxiety

Establish prognosis and set realistic expectations

76
Q

PNE is most sucessful with use of

A

metaphors, examples and pictures

77
Q

the way they assess pain ____ (PNE

A

can ignite the pain neuromatrix

78
Q

billing for PNE

A

neuro re-ed

79
Q

PNE 4 pillars

A

Pain Education
Aerobic Exercise
Sleep Hygiene
Goal Setting

80
Q

pain edu pne

A

Introduce metaphors, examples or pictures applicable to the nature of the patients problem

81
Q

pne exercise

A

Important to encourage physical activity as early as possible
Benefits of physical activity on chronic musculoskeletal pain are widely accepted

make sure they know exercise is safe

82
Q

why combine pne and exercise

A

PNE combined with exercise or manual therapy is far superior

83
Q

national guideline for aerobic exersice

A

150 minutes of moderate intensity activity per week

75 minutes of vigorous activity per week

84
Q

resistance exercise for pne

A

Familiarize patient with the exercise

Engaging non-painful body parts can have a positive impact on pain

85
Q

aerobic exercise pne

A

20-60

> 2x wk for 6wks

86
Q

sleep hygiene pne

A

Lack of sleep negatively affects wellness and is associated with increased rates of pain, obesity, depression and increased risk for cancer and other health-related disorders

87
Q

HEP 4 tasks

A

Q - regaurding pain or PNE
exercise - breathing relaxign
aerobic exercise
goals

88
Q

In chronic pain, chemicals associated with stress can directly activate nociception pathways (danger messenger nerves)

A

true

89
Q

GMI

A

identify LR discrimination

motor imagery

mirror therapy

90
Q

why L/R discrimination in those with pain

A

Research demonstrates that left/right discrimination is impaired in individuals with chronic pain
Normalization of left/right discrimination is important for recovery from chronic pain

91
Q

LR discrimination parameters
accuracy
speed

A 
Accuracy 
≥80% 
Speed
1.6 seconds +/- 0.5 secs for Neck/back
2 seconds +/- 0.5 secs for Hands, feet, shoulders, knees
92
Q

easiest to perform at (LR descrimination pne

A

Easiest to perform at 0

Individuals are slower and less accurate at 90, 270 and 180

cp3 (2 decks)

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