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principles of intervention Flashcards

1
Q

discuss the characteristics of acute stage

A

aka reaction or inflammatory stage

lasts 4-6 days from injury; unless re-injured

cardinal signs of inflammation
pain at rest and before tissue resistance
impaired ROM d/t pain or muscle guarding
dec use of assoc parts

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2
Q

discuss the characteristics of subacute stage

A

aka proliferation, repair or healing stage

lasts 10-17 days; 6 wks if tendon

signs of inflammation dec or absent
paint during tissue resistance and end range
impaired ROM d/t contractures, tightness, atrophy
dec function and strength from disuse

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3
Q

discuss the characteristics of chronic stage

A

aka maturation and remodeling stage

lasts for 6 mon - 1 yr

(-) signs of inflammation
pain after tissue resistance
impaired ROM d/t weakness, poor endurance, poor muscle control
dec or unable to function

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4
Q

what are the signs of inflammation

A

paint at rest - dolor
swelling - tumor
redness - rubor
heat - calor
loss of function - functio laesa

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5
Q

when does scar retraction occur

A

day 21 - chronic stage

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6
Q

remodeling time is influenced by factors that affect ________

A

density and activity of fibroblasts

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7
Q

give factors that affect density and activity of fibroblasts

A

time of immobilization
stress placed on tissue
location of lesion
vascular supply

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8
Q

differentiate the state of healing between late subacute and chronic

A

late subacute - formation of collagen and tissue; fragile and poorly oriented

chronic - improved quality of collagen tensile strength and orientation and reduction of wound size

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9
Q

area at high risk of injury in skeletal muscle

A

myotendinous junction

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10
Q

common MOI for muscle injuries

A

high demand or high impact activity - strain

direct trauma - contusion

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11
Q

discuss classification of muscle injuries

A

grade 1 (minor) - tearing few fibers; minimal strength loss

grade 2 (moderate) - tearing of more fibers (partial); loss of contractile strength

grade 3 (severe) - cross sectional rupture; complete loss of strength

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12
Q

characteristics of destruction phase in muscle injuries

A

necrosis of torn fibers
hematoma and inflammation
fibrin and fibronectin provide support against contraction

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13
Q

characteristics of repair phase in muscle injuries

A

after few days to few weeks post-injury

phagocytosis of necrotic tissue
regeneration of contractile elements
myofiber formation and scar formation

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14
Q

characteristics of remodeling phase in muscle injuries

A

after 4-6 wks post-injury

re-organization of tissue integrity and functional maturation

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15
Q

compare the healing of small and large muscle injuries

A

small - muscle tissue
large - scar tissue

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16
Q

give clinical implications for rehab of muscle injuries

A

rest vv important in early phase to promote healing

use modalities to control inflammation, edema, stiffness, pain

early activity at available range to prevent adhesions, contracture and dec strength

no active stretching 3-7 days post-injury to prevent re-injury

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17
Q

when can active stretching can be done in rehab of muscles ?

A

bawal 3-7 days post-injury pero pwede na after

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18
Q

common MOI tendinopathy

A

repetitive motions, loading (overuse) = microtears or abrupt forceful contraction

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19
Q

usual time frame for achilles tendon rupture in terms of healing and return to sports

A

12-16 wks to heal after injury

return to sport after 3-6 months

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20
Q

characteristics of inflammatory phase in tendinous injuries

A

acute - few days to wks after injury

(+) signs of inflammation

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21
Q

characteristics of proliferative phase in tendinous injuries

A

few days to few weeks after injury and up to 6 wks

collagen synthesis
correct faulty biomech and compensatory posture/motions

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22
Q

characteristics of remodeling phase in tendinous injuries

A

about 6 wks after injury

fibrous repair; collagen aligns based on direction of stress placed on tendon (strengthening starts but no too intense)

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23
Q

characteristics of scar formation phase in tendinous injuries

A

10 wks to 1 yr

decline of tendon metabolism and vascularity
strengthening in tissue continues (pwede na higher intensity)

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24
Q

give clinical implications for rehab of tendinous injuries

A

avoid prolonged immob

identify postural dysfunction or biomech fault to reduce improper loading on tendon

strengthening and stretching designed for remodeling then progress if in scar formation na

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25
common MOI for ligamentous injuries
from excessive lengthening of ligament
26
most commonly injured ligaments
lateral ankle ligaments tas ACL
27
discuss grade 1 ligamental injury
stretched ligament; no excessive motion few fibers in plastic range ruptured; intervention and protection
28
discuss grade 2 ligamental injury
partial tear in ligament; moderate joint laxity surgery is dependent on instab and goals of pt
29
discuss grade 3 ligamental injury
complete ligament rupture; significant joint laxity surgical intervention
30
discuss inflammatory phase in ligamental injuries
starts within 72 hrs after injury (+) hematoma and signs of inflammation deposition of ground substance and disorganized collagen
31
discuss regenerative phase in ligamental injuries
few days up to 6 wks after injury fibroblast proliferation and collagen formation
32
discuss remodeling phase in ligamental injuries
6 wks post-injury up to 1 yr remodeling of ligament and improved collagen orientation
33
clinical implications for ligamental rehab
avoid prolonged immob stress ligament during proliferative and remodeling = more organized collagen
34
common MOI for bone injuries
trauma or accident overuse aging or osteoporosis cancer metabolic abnormalities
35
discuss hematoma formation phase in bone healing
initial 48-72 hrs post-injury hematoma = fibrin meshwork where fibroblasts and capillaries surround
36
discuss cellular proliferation phase in bone healing
osteogenic cells proliferate = forms fibrocartilage collar
37
discuss callus formation face in bone healing
cont proliferation turns collar into callus healing of bone begins; slower in geriatric tas faster sa kids then adult
38
discuss ossification face in bone healing
osteoblasts replace cartilage = ossification of callus
39
discuss consolidation and remodelling face in bone healing
up to a teat to complete callus is reabsorbed and bone remodels based on stress placed
40
clinical impli for bone rehab
immob until may callus na - repeat xrays; callus = mob; if atrophy na tas wala pdin callus consult ortho treat soft tissue damage with modalities once mobilization is allowed dapat may progressive strength regime to reverse atrophy controlled WB as reco ng ortho
41
common MOI for cartilage
trauma or degeneration or overuse from faulty biomech
42
discuss grade 0 cartilage injury
normal cartilage
43
discuss grade 1 cartilage injury
superficial lesions, rough surface and chondral softening intact surface
44
discuss grade 2 cartilage injury
lesions extending < 50% of cartilage depth; abnormal irreg surface defects < 50% of cartilage depth; ulcerations, fissuring, fibrillation
45
discuss grade 3 cartilage injury
lesions extending > 50% of cartilage depth; severely abnormal irreg surface defects > 50% of cartilage depth; ulcerations, fissuring, fibrillation
46
discuss grade 4 cartilage injury
extends to subchondral bone; full thickness injury cartilage loss and exposes bone
47
discuss healing process of cartilage damage
lack of blood supply impedes regeneration
48
exp how cartilage injury cause pain
aneural in general but OA - no cartilage = bone to bone contact (may nociceptors) = pain meniscal tear - pain d/t abnormal biomech, plica or inflammation of soft tissue
49
clinical impli for rehab of CARTILAGE damage
focus on restoring normal joint mob, dec inflammation and pain and correcting faulty biomech and postures as well as dysfucntions in muscle activation avoid excessesive WB
50
usual MOI for nerve damage
direct - compression, tension, laceration, stretch, electricity, radiation indirect - poor circulation, temp, chemicals
51
discuss nueropraxia
segmental demyelination AP is slowed or blocked; no muscle atrophy and temporary sensory loss d/t mild ischemia from compression complete recovery
52
discuss axonotmesis
loss of axonal cont; wallerian degen muscle atrophy and sensory loss d/t prolonged compression and stretch = necrosis and infarc incomplete recovery and may require surgery
53
discuss nuerotmesis
complete severance of nerve fiber; wallerian degen muscle atrophy and sensory loss d/t GSW, stabs, avulsion rupture no recovery w/o surgery
54
discuss sunderland type 1
neuropraxia, minimal disruption complete recovery
55
discuss sunderland type 2
axonotmesis; wallerian and disruption of axon usually complete recovery
56
discuss sunderland type 3
axonotmesis or neurotmesis; wallerian and disruption of axon, endoneurium poor prognosis s surgery
57
discuss sunderland type 4
neurotmesis; wallerian and disruption of axon, endoneurium, peri poor prognosis s surgery
58
discuss sunderland type 5
neurotmesis; wallerian and disruption of axon, endoneurium, peri, epi - complete disruption poor prognosis s surgery
59
discuss acute phase in healing PNI
immed after injury or surgery minimize inflammation and tension to promote healing
60
discuss recovery phase in healing PNI
signs of re-innervation focus on re-training and re-education of muscle
61
discuss chronic phase in healing PNI
re-innervation potential peaked focus on training of compensatory techniques
62
clinical impli for rehab of PNI
observe if pt regains strength and sense ona rea provide favorable environment for healing maintain normal ROM and neural mobilizaition to prevent contractures and promote nerve gliding use modalities for sensory or motor re-education (ES)
63
goals of treatment in the protection phase
control effects of inflammation faci wound healing maintain normal function in assoc areas
64
goals of treatment in the controlled motion phase
promote healing nondestructive exercises restore mob and function
65
goals of treatment in the return to function phase
inc strength and flexibility return to functional and work activities
66
goals of treatment if post op
max, mod and min protection phase
67
interventions in protection phase
PRICES, immob to control inflammation passive movement to promote mon massage to reduce swelling
68
interventions in controlled motion phase
AROM, isometrics, endurance and stabilization exercise, functional training hold-relax stretching, passive stretching and massage
69
interventions in return to function phase
progressive stretching and cross fiber massage indep = strengthening, endurance, aerobic training specificity drills
70
precautions and contraindications in protection phase
pre - proper dosage of rest and movement contra - stretching and resistance
71
precautions and contraindications in controlled motion phase
pre - proper dosage of rest and movement, eccentric and heavy resistance exercises

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