Modalities Ch. 6

Question 1

orthopedic injury model

Answer 1

normal tissue

• cells
• two blood vessels
• nerve

Question 2

immediate ultrastructural change

Answer 2

primary traumatic damage
damage to the nerve
breakdown of the injured cells

Question 3

hemorrhage

Answer 3

few minutes only

clot forms, stopping hemorrhage

Question 4

what happens of a clot forms

Answer 4

hematoma forms

Question 5

how does a clot form

Answer 5

fibrins form a network

-platelets are caught and it created a plug

Question 6

pain from damaged nerve

-results

Answer 6

muscle spasm and more pain
neural inhibition
-leads to decreases in strength and ROM

Question 7

the damaged cells release…

Answer 7

chemical mediators as a signal to the body that an injury has taken place

Question 8

result of broken blood vessels

Answer 8

extravascular swelling

Question 9

chemical mediators released from dying cells cause…

Answer 9

hemodynamic changes
permeability changes
-histamine
-kinins
-serotonin
leukocyte migration

Question 10

what happens at this point?

Answer 10

secondary enzymatic injury

Question 11

hemodynamic changes

Answer 11

blood flow slows down
OR
blood flow ceases
result
-tissue oxygen decreases
--hypoxia
--metabolic changes
-secondary hypoxic injury soon seen

Question 12

phagocytosis

Answer 12

as cells are broken down free proteins are released

free proteins signal edema

Question 13

pressure on undamaged nearby pain fibers cause additional…

Answer 13

pain

muscle spasm and inhibition

Question 14

immediate care

Answer 14

subset of acute care

first 12 hours

Question 15

RICES

Answer 15

Rest
Ice
Compression
Elevation
Stabilization

Question 16

why RICES?

Answer 16

protection from further damage
decrease or minimize the development of
-swelling
-pain
-muscle spasm
-neural inhibition
-secondary injury
-total injury (because of decreased secondary injury)

Question 17

time course of swelling

Answer 17

immediate swelling
-comes from hemorrhaging
edema
-begins minutes to hours after injury
-continues to develop over many hours

Question 18

secondary injury and edema

Answer 18

secondary injury leads to edema
increased edema increases secondary injury
two mechanisms
-increased distance between blood vessel and tissue cells
-edema can compress the blood vessel
both decrease circulation
-decreased oxygen to tissues

Question 19

rest: why?

Answer 19

limits injury aggravation

• should be total during immediate care
• transition to “relative” rest
• different from, but related to, stabilization

Question 20

ice: why?

Answer 20

most think it’s to control swelling
-important but only part of immediate care
limiting secondary injury and neural inhibition are most important than controlling swelling

Question 21

decreased blood flow theory

Answer 21

older, traditional theory
cold decreases blood flow
logic of theory
-cold causes vasoconstriction
-vasoconstriction decreases blood flow
decreasing blood flow decreases hemorrhaging
decreased hemorrhaging = swelling reduced

Question 22

decreased blood flow theory flaw

Answer 22

clotting occurs before tissue is cooled enough to substantially decrease blood flow

Question 23

decreased secondary injury theory

Answer 23

cold decreases cellular metabolism

• reduces oxygen demand (consumption)
• less secondary hypoxic injury
• less total injury
• less free protein generated by phagocytosis
• less edema

Question 24

metabolism and cooling

Answer 24

direct relationship

-greater cooling = greater decrease in metabolism

Question 25

cryotherapy and swelling

Answer 25

decreases edema, not hemorrhage
-most occurs hours after injury, as free protein accumulates from phagocytosis
cold reduces edema formation
-by preventing secondary injury and thus less free protein accumulation

Question 26

compression: why?

Answer 26

controls edema beyond normal volume (i.e. after tissue spaces are filled)
slows swelling
apply constantly until swelling is over

Question 27

compression during immediate care

-RICES added benefit

Answer 27

enhances cooling

Question 28

elevation: why?

Answer 28

decreases capillary hydrostatic pressure

Question 29

stabilization: why?

Answer 29

controls neural inhibition
-process in which neural pathway is blocked so impulses cannot pass
–intended function does not occur
-partial: function is diminished
-total: function is abolished temporarily
allows muscles to relax, thus
-decreases pain-spasm-pain cycle
-numerous braces and splints for stabilization

Question 30

cryotherapy physics and physiology

Answer 30

cold = the absence of heat
conduction
-heat exchange until two substances have exchanged energy and meet in the middle

Question 31

rate of conduction factors

Answer 31

temperature differential
regeneration of body heat and modality cooling
heat storage capacity
size of the cold modality
amount of tissue in contact with pack
length of application
individual variability

Question 32

heat storage capacity principles

Answer 32

specific heat

latent heat of fusion

Question 33

specific heat

Answer 33

amount of heat energy required to raise 1 kg of a substance 1 degree C

Question 34

latent heat of fusion

Answer 34

amount of heat energy need to convert a substance from a solid state to a liquid state
-phase change
ice to water = 80 cal/kg

Question 35

crushed ice pack vs. gel pack

Answer 35

crushed ice is better
-gel pack approx. 22 kcal
--water from -17 C to 5 C
crushed ice pack approx. 86 kcal
-phase change
-from -1 C to 0 C

Question 36

factors that affect tissue cooling

Answer 36

type of cold pack
duration of application
size of cold pack
amount of tissue in contact with pack
depth of target tissue
method of application

Question 37

factors affecting temperature changes after cold pack application

Answer 37

depth of tissue
amount of heat available to rewarm area
activity level before cryotherapy
amount of heat removed from body during application (magnitude and duration of cold application)

Question 38

types of cold packs

Answer 38

four general types

• crushed ice
• gel
• artificial ice
• chemical

Question 39

crushed ice

Answer 39

most effective because of heat of fusion
excellent for on-the-field use
should not be used if kept in a freezer (too cold)

Question 40

gel pack

Answer 40

water, alcohol, and gel substance
cooled to 1 F
-dangerous
should only be applied with barrier between skin and pack

Question 41

artificial ice

Answer 41

water in vinyl pouches, surrounded by nylon cover (Dura Kold)
better than gel because of heat of fusion
not as good as crushed ice because of insulation from nylon cover
good for home use

Question 42

chemical: double bags, crushable

Answer 42

chemical reaction when inner bag is crushed and contents react with outer chemicals
least cooling

Question 43

frozen peas

Answer 43

popular; cheap and convenient
effects
-better than nothing and gel packs
-worse than crushed ice packs or ice water immersion
-little phase chang with peas
avoid if possible

Question 44

cold application protocol

Answer 44

apply directly to skin, not over a towel or elastic wrap

• except for gel packs
• except for crushed ice from freezer

Question 45

cold: length of application

Answer 45

intermittent
-30-60 minutes every two hours
depth of target tissue
adipose tissue - leave on longer

Question 46

average ice times based on area

Answer 46

finger: 20 minutes
ankle or arm: 30 minutes
thigh: 45 minutes
+5 minutes for each millimeter of skin-fold >1 mm