Mod. 1-3 Flashcards by Alyssa Donley

What is a physiological justification for tx?

what is (physiologically)happening to the tissue
how intervention is working towards goal (on provider level)

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What is clinical justification?

the impact on pt’s function (for reimbursement purposes)
convince pt why exercise is important

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mode of energy using direct contact between agents (heat transferred from high to low)

conduction

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mode of energy using direct contact with a circulating medium with different temperature material

convection

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mode of energy with heat transfer when a liquid absorbs energy and changes to a vapor

evaporation

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mode of energy transfer from high to low temp without medium or direct contact

radiation

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5 cardinal signs of inflammation

heat, redness, edema, pain, loss of function

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how long does inflammatory phase last

1-6 days

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Name 3 stages of tissue healing

inflammation
proliferation
maturation/remodeling

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what happens during proliferation phase of healing

granulation tissue forms
fibroblasts deposit collagen
angiogenesis (new blood vessel formation)

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describe A-beta fibers

large, myelinated
fastest transmission
transmit non-noxious stimuli
gate control theory

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describe A-delta fibers

small & myelinated
medium transmission of noxious stimuli
transmit “fast pain”/acute sensation
not blocked by opioids

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describe C fibers

smallest, unmyelinated
transmit noxious stimuli (diffuse, chronic pain)
blocked with opioids

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Ascending pathway: synapse area?
which NT released?
destination of relay signal?

substantia gelatinosa
substance P
thalamus in brain

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pain type: ill-defined, diffuse; travel/expands to other areas

radiating

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pain type: sensation originates from somewhere other than pain site

referred

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pain type: sharp pain that travels along nerve pathway (usually from neck/spine)

radicular

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pain type: musculoskeletal (tendons, joints, mm)

somatic

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pain type: accompanied by s/s of neuro dysfunction (ex: pins, needles, tingle)

neuropathic

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pain type: unlocalized, referred pain from receptors in vital organs

visceral

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gate control theory: which nerve fiber blocks others?
interneuron stimulated to release what?
inhibits release of what?

A-beta fibers
enkaphalin
substance P

Name 4 pain scale types

visual analog scale
numeric rating scale
Wong-Baker faces
body diagrams
McGill questionairre (descriptor words)

how deep into tissues do superficial thermal agents affect?

2 cm

Name 3 indications for thermotherapy

abnormal tone
subacute/chronic pain
decreased ROM
myofascial trigger points
mm guarding & spasm

Name 3 physiological effects of thermotherapy

increased nerve conduction vasodilation inc. pain threshold (gate control) inc. collagen extensibility altered tissue extensibility dec. muscle strength inc. metabolic rate/activity dec. neuron firing rate & mm spasm

Name 3 contraindications for thermotherapy

acute inflammation/injury peripheral vascular disease area of compromised circulation arterial disease bleeding/hemorrhage thrombophlebitis area of malignancy

Moist hot pack parameters: temp, tx time, layers

~160* 15-20 min 6-8 layers

Contrast bath parameters: temps, tx time

hot: ~105* cold: ~ 55* 25-30 min

Paraffin bath dip-wrap parameters: temp, # dips, tx time

130* 6-10 dips 10-15min

paraffin bath parameters (dip immersion & paint): temp, dips/paint layers, tx time

~130* 6-10 dips/paint layers 20 min (submerge w/ unit off)

Name 3 cryotherapy indications

acute/subacute/chronic pain or inflammation bursitis abnormal tone muscle spasm myofascial trigger points musculoskeletal trauma tendonitis, tenosynovitis

contraindications for cryotherapy

cold intolerance peripheral vascular disease area of compromised circulation infections skin anesthesia (reduced sensation) Raynaud's disease regenerating peripheral nerves cold urticaria (hives) (paroxysmal cold hemoglobinuria cryoglobulinemia)

Name 3 physiological effects of cryotherapy

vasoconstriction inc. blood viscosity dec. nerve conduction velocity inc. pain threshold (gate control) altered muscle strength dec. muscle spasm dec. spasticity dec. metabolic activity facilitation of muscle contraction

Cold Pack Parameters: temp, tx time, layers

~25* 15-20 min 1 moist layer

Ice Massage Parameters: time, layers, area

5-10 min direct contact to skin smaller contoured, localized areas

Cold compression parameters: temp, pressure, tx time

~60* max 60 mm Hg 15-20 min

cold immersion parameters: temp, tx time

60* 15-20 min

Vapocoolant spray parameters: sweep # & direction, inches from skin

2-5, distal to proximal 12-18 in from skin inc. stretch each time

TENS indications

pain (acute, chronic)

Name 5 TENS & IFC contraindications

cardiac pacemaker cardiac arrhythmia over pregnant uterus over carotid sinus (anterior neck) malignancy infection phlebitis seizure disorder osteomyelitis bladder stimulator *no low rate TENS if mm contraction would disrupt acute healing

Physiological Effects of TENS

pain relief (gate control or endogenous opioid)

Conventional/High Rate TENS parameters: frequency, pulse duration, amplitude, tx time, pain mechanism

30-150pps 50-100 us to sensory response (acute pain) as needed (max 24 hrs) gate control

Acupuncture-like/Low-Rate TENS parameters: frequency pulse duration amplitude tx time pain mechanism

2-10pps 100-300 us to motor response (mm twitch)/chronic pain 20-30 min endogenous opioid

name 3 IFC indications

pain (acute, chronic) dec. circulation edema muscle spasm muscle stimulation- for stress incontinence

physiological effects with IFC

pain relief (gate control, endogenous opioid) inc. local blood flow muscle stimulation

IFC Pain Control (Gate theory) Parameters: beat frequency, amplitude, tx time

80-200 Hz sensory (low, tingling) 20-30 min

IFC Pain Control (endogenous opioid) Parameters: beat frequency, amplitude, tx time

0-10 Hz muscle twitch 20-30 min

IFC Inc. Blood Flow/MM Stim. Parameters: frequency, amplitude, tx time

10-20 or 25 Hz muscle twitch 20-30 min

IFC quadripolar vs. bi-polar/pre-mod

quad: 2 channels, 4 electrodes in "X" criss-cross vector pre-mod: 1 channel, 2 electrodes w/ oval vector (more diffuse)

IFC Fixed vs. sweep

fixed: keeps same beat frequency within machine sweep: timed, fluctuation between 2 different (high/low) frequencies