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summer 2021 > PT 1 > Flashcards

PT 1 Flashcards

1
Q

acute pain is described as pain lasting ——

A

less than 12 weeks

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2
Q

acute pain is associated with ——-

A

an actual physiological event

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3
Q

examples of physiological events include?

A

tissue damage, infection, trauma, metabolic disorder. degenerative disease

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4
Q

an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage- describes

A

pain

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5
Q

what is the most common symptom that leads patients to seek medical intervention

A

pain

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6
Q

this is an important protective sensation

A

pain

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7
Q

generally described as pain lasting less than 12 weeks

A

acute pain

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8
Q

this pain is associated with an actual physiological event

A

acute pain

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9
Q

examples of physiological event include

A

tissue damage, infection, trauma, metabolic disorder, degenerative disease

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10
Q

this pain is described as persistent or recurrent pain existing for longer than 3 months

A

chronic pain

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11
Q

pain that persists beyond the normal time expected for healing of injured tissue

A

chronic pain

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12
Q

this pain is difficult to manage

A

chronic pain

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13
Q

clinicians must rely on a multidisciplinary approach and should involve more than one therapeutic modality

A

chronic pain

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14
Q

described as pain that occurs at a site remote from the source of the disease or injury

A

referred pain

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15
Q

this pain is usually a visceral or muscle source

A

referred pain

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16
Q

treating pain of ____ or ____ origin is generally considered a contraindication to care

A

unknown unidentifiable

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17
Q

we do not have pain receptors- t/f

A

true

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18
Q

pain is an ___ of the brain. _____ are threat receptors

A

output nociceptors

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19
Q

this pain serves to protect against further tissue damage, when injury is present, pain can be maintained in order to allow rime for proper tissue healing

A

acute pain

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20
Q

this pain is is associated with changes in heart rate, blood pressure and even respiratory rate, measurement of vital signs is warranted

A

acute pain

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21
Q

superficial pain is typically sharp and easy to locate

A

acute pain

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22
Q

deep tissue pain from muscles, joints or viscera can be diffuse and difficult to locaate

A

acute pain

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23
Q

pain that is persistent or recurrent pain existing longer than 3 months or beyond the normal time expected for healing of tissue

A

chronic pain

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24
Q

pain that was once acute but has persisted beyond the normal time expected for healing and no longer serves as a protective mechanism

A

chronic pain

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25
Q

associated with structural and functional changes in the central nervous system that require multiple therapeutic approaches

A

chronic pain

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26
Q

central sensitization or the amplification of neural signaling within the central nervous system that underlies pain hypersensitivity, is a characteristic of _____

A

chronic pain chronic pain

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27
Q

this pain is difficult to manage- must rely on a multidisciplinary approach and should involve more than one therapeutic modality

A

chronic pain

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28
Q
  1. patients with this pain report physical inactivity due to long periods of immobility due to decreased muscle strength and functional capabilities
A

chronic pain

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29
Q

this type of pain can pose significant financial and public health considerations as noted in rising costs of pharmacological management and challenges to medical care models

A

chronic pain

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30
Q

pain that occurs at a site remote from the source of the disease or injury, usually a visceral or muscle source

A

referred pain

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31
Q

pain that occurs due to convergence of cutaneous visceral and skeletal muscle nociceptors on the common nerve root of the spinal cord

A

referred pain

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32
Q

the brain interprets the afferent input as arising from cutaneous structures because of the higher proportion of cutaneous afferents converging on second order transmission neurons

A

referred pain

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33
Q

treating pain of unknown or unidentifiable origin is generally considered a?

A

contraindication to care

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34
Q

masking undiagnosed pain with treatment can postpone proper treatment and lead to

A

worsening of the underlying condition

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35
Q

pain conditions assumed to be predominately driven by the activation of peripheral nociceptive sensory fibers

A

nociceptive pain

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36
Q

amplification of neural signaling within the central nervous system that elicits hypersensitivity

A

nociplastic pain

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37
Q

pain attributable to a lesion or dysfunction in a peripheral nerve, dorsal root ganglion or dorsal root

A

neuropathic pain

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38
Q

regarding the gate control theory: early discussions on paing modulation were centered on the ____ pathways and recognizing the presence of _____ influences to modulate pain.

A
  • ascending pathways
  • descending pathways
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39
Q

gate control theory: noxious stimuli carried by ______ and _____ are blocked by sensory input carried by ______

A
  • A-delta fibers
  • C-fibers
  • A-beta fibers
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40
Q

descending pathways lead to the release of ? to mask pain

A

endogenous opiates like endorphins and enkephalins

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41
Q

nociceptive input are _____ carried by ____ and ______ which are ______

A

pain signals, A-delta, C-fibers, 1st order neurons

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42
Q

where can nociceptors be found?

A

skin, muscle, joints, bone and viscera- they have a high threshold for activation

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43
Q

how is threshold of nocicpetors lowered? using what?

A

lowered by release of chemical substances after tissue injury and inflammation- using prostaglandins, bradykinins, histamine.

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44
Q

prostaglandins, bradykinins, and histamine do what to the nerve endings

A

sensitize- lowering the threshold of nocicptors

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45
Q

these fibers are tin myelinated fibers that respond to high intesity mechanical or thermal stimuli

A

a-delta or group III fibers

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46
Q

responsible for fast conducting peripheral pain signals

A

a-delta or group III fibers

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47
Q

associated with the first pain sensations, precise location of noxious stimuli on the body, and generation of withdraw reflexes

A

a-delta or group III fibers

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48
Q

unmyelinated and thin fibers, respond to a broad range of painful stimuli, including mechanical, thermal or chemical

A

c or group IV fibers

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49
Q

because C fibers respond to such a broad range of stimuli they are also called?

A

polymodal fibers

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50
Q

pain produced by activation of these fibers is considered second pain and characterized as slow, dull, aching, burning and long lasting

A

c-fibers or group IV

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51
Q

c-fibers long lasting pain modal acts to do what?

A

prevent further tissue damage

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52
Q
  • high threshold
  • myelinated
  • 1-5 um in diameter
  • fast conducting
  • responds to high intensity heat, cold and mechanical stimuli
  • generates fast/first pain with withdraw reflexes and sesations
    • associated with precise location of mxious stiumuli on the body
A

A-delta fiber

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53
Q
  • high threshold
  • unmyelinated
  • 0.1-1um in diameter
  • slow conducting
  • responds to high intesity heat, cold, mechanical and chemical stimuli- polymodal
  • generates slow second pain sensations
  • assoc. with prevention of further tissue damage
A

c-fibers

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54
Q

non-nociceptive input is carried by?

A

a-beta fibers

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55
Q

large-diameter afferent fibers- when activated these fibers send excitatory stimuli that activates the substantia gelatinose interneurons located in the dorsal horn of the spinal cord- these inhibit the pain fiber terminals and t cell activity

A

a-beta fibers

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56
Q

______ interneurons of _____ fibers close the gate to nociceptive traffic and reduce pain

A

substantia gelatinose SG, A-beta fibers located in dorsal horn

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57
Q

diameter and velocity list greater to lesser.

A
  • A-alpha
  • A-beta
  • A-Gamma
  • A-delta
  • B
  • C
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58
Q

somatic motor, proprioception, muscle spindle, golgi tendon organ

A

A-alpha

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59
Q

touch, pressure

A

a-beta

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60
Q

pain, cold, touch

A

a-delta

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61
Q

dorsal root, pain, hot, other mechanoreceptors, postgangliotic sympathetic

A

c-fibers

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62
Q

myelinated fibers include?

A

Ia, Ib, II, III

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63
Q

unmyelinated fibers include?

A

IV- c fibers

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64
Q

Central Pathways: First order neurons which include ? Make direct or indirect synapses through ? With second order neurons in the (location?)

A
  • A-delta and c fibers
  • Inter neurons
  • Dorsal horn of the spinal cord
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65
Q

Central Pathways: second-order neurons (also called ?) transfer the nociceptive impulses from the spinal cord and brain stem to ?

A
  • central nociceptive transmission neurons
  • higher centers of the brain
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66
Q

Central Pathways- what are the 2 types of second order neurons?

A
  • nociceptive specific second order neuron
  • wide dynamic range second order neuron
67
Q

central pathways: known as a high threshold neuron, that receives input from peripheral nociceptors only

A

nociceptive specific second order neuron

68
Q

central pathway: receives input from both nociceptive and non nociceptive primary afferent fibers

A

wide dynamic range neuron WDR

69
Q

what is the main pathway responsible for transmitting nociceptive input from somatic and visceral tissues to higher centers?

A

spinothalamic tract STT

70
Q

describe the STT pathway

A
  • cross midline at the spinal cord level at the anterior white commissure
  • ascends to ventroposterior lateral thalamic nucleus and medial thalamic nuclei
71
Q

describe the pathway of spinomesencephalic tract

A

ascends to the midbrain and terminates in PAG

72
Q

this tract may activate a descending inhibitory system that promotes analgesia due to the release of serotonin

A

spinomesencephalic tract

73
Q

describe the spinoreticular tract pathway

A

ascend to the medullary reticular formation and to the pontine reticular formation

74
Q

this tract allows for suppression or facilitation of pain and is involved in the motivational, emotional, and unpleasant components of pain

A

spinoreticular tract

75
Q
  • max von frey
  • individual pain receptors transmit signals to specific pain center in brain- which sends back instructions for motor reponse
  • theory is based on assumption that there is pain system
A

specificity theory

76
Q
  • this theory fails to acknowledge the psycholgical aspect of pain or the role of prior experience in making us hypersensitive to pain stimuli
    • there is no pain system
A

specificity theory

77
Q
  • Nafe and Scheider
  • pain receptors are shared with other bodily systems
  • the brain only get a pain signal if combo of stimuli formed in the spinal cord, leads to implementation of preset pattern of response
A

pattern theory

78
Q

this theory underestimates the role of the brain - it is not just receiver of messages from receptors.

A

pattern theory

79
Q
  • melzack and wall
  • all peripheral sensations are transmitted by peripheral nerve stimulation
  • this stimulation is transmitted to the spinal cord and if threshold is met it is transmitted to the brain for processing.
  • pain sensation is carried by nociceptive pain fibers- a-delta and c-fibers
  • fibers go to dorsal horn of spinal cord- stimulate second order neuron, travel spinothalamic tract to the brain for interpretation
  • if touch is added we stimulate a-beta fibers which stimulate inhibitory interneuron in the dorsal horn- which diminshies pain sensation - this is why we squeeze or rub
A

gate theory

80
Q

this theory makes sense but does not explain whose in which nociceptor are not stimulated and yet a person still experiences pain (phantom pain)

A

gate control theory

81
Q

this theory states that pain inhibits pain- two noxious stimuli are applied at the same time- the second in the same area but different spot- the second stimulus is processed by the dorsal horn and can inhibit the first noxious stimuli.

A

conditioned pain modulation

82
Q

emphasizes the role of the brain, shifting focus to components of the central nervous system- pain is the output of the brain, there are multiple influences on pain outside of peripheral nociceptive stimulation

A

neuromatrix of pain

83
Q

emphasizes the brains decision to create a pain sensation and diminishes the input from peripheral tissue. peripheral noxious stimulation still plays a large role in creating of pain but it does not provide the. entire story

A

neuromatrix of pain

84
Q

explains phantom limb pain, fibromyalgia, NSLBP, and other chronic pain conditions where nociceptive stimulation is not present but the sensation of pain persists

A

neuromatrix of pain

85
Q

modulating pain is a central focus on what part of rehabilitation?

A

in all stages- pain may limit or preclude rehabilitative efforts to restore or increase function.

86
Q
  • vasoconstriction
  • vasodilation
  • hemostasis-clot formatiom
  • cell-mediated phagocytosis
    *
A

stage I, inflammation phase

87
Q
  • epithelialization
  • collagen production
  • closure/contraction
  • revascularization
A

stage II, proliferation stage

88
Q
  • collagen balance- synthesis/lysis
    • collagen remodeling
A

stage III, maturation state

89
Q

what is the normal healing process?

A

inflammation, proliferation, maturation

90
Q

this is the bodys nonspecific defense mechanism and begins immediately following injury

A
91
Q

can be triggered by a variety of causes, trauma, disease, pathogens, allergic reaction

A

inflammation

92
Q

characterized by degrees of redness, warmth , pain, swellng and loss of function- these are the cardinal signs of ?

A

inflammation

93
Q

during what phase does hemostasis occur?

A

inflammatory phase

94
Q
  • responsible for stopping bleeding at the injury site
  • platelets adhere to exposed collagen and form a clot that stops the bleeding- they play a role in later stages of healing due to growth factors they produce
A

hemostasis

95
Q

edema continues to accumulate in the injured area due to extravasation, which is movement of fluid from the blood vessels into the extravascular space- what phase

A

inflammation phase

96
Q

distention of the local tissues and irritation of the free nerve endings in the injured area can result in pain- what phase is this?

A

inflammatory phase

97
Q

tissue distension creates space for the influx of phagocytic cells and proteins that set the stage for later phases of healing- what phase is this?

A

inflammatory phase

98
Q

the function of this phase is to repair the defect

A

proliferation

99
Q

this phase can last several weeks, depending on the injury- fibroblasts and keratinocytes predominate- what phase is this?

A

proliferation

100
Q
  • in this phase fibroblasts are attracted to the wound by macrophages in the inflammatory phase
A

proliferation phase

101
Q
  • these typicaly arrive in the area 48-72 hours after injury
    • they lay down collagen and elastin which replace the tissue that was damaged during inflammatory process
A

fibroblasts in proliferation stage

102
Q

if the injury resulted in skin break ______ will also be important to cover the wound with a new layer of epithelium - what phase is this?

A

keratinocytes- proliferation phase

103
Q

phagocytic white blood cells are responsible for cleaning the wounded area of nonviable material so the proliferative phase can begin- what phase?

A

inflammatory phase

104
Q

the function of this phase is to remodel the newly formed collagen matrix- collagen matrix is rearranged and continues to gain tensile strength- this phase is the longest and can last up to one year

A

maturation phase

105
Q

wound healing is divided into 3 stages plus _____ ? what are they?

A
  • hemostasis
  • inflammation
  • proliferation
  • maturation-remodeling
106
Q

basic wound healing: disruption of the vascular endothelium and exposure of the basal lamina which results in extravasation of blood and platelet activation. release of growth factors involved in extracellular matrix- growth factor 6- chemotaxis (platelet derived growth factor) epitherlialization (fibroblast growth factor and epidermal growth factor) and angiogenesis (vascular endothelial growth factor) - this is phase?

A

hemostasis

107
Q

transforming growth factor 6- used in what phase?

A

extracellular matrix- hemostasis

108
Q

platelet derived growth factor- used in what phase

A

chemotaxis- hemostasis

109
Q

fibroblast growth factor and epidermal growth factor- used in phase?

A

epitheliaization- hemostasis

110
Q

vascular endothelial growth factor- used in phase?

A

angiogenesis- hemostasis

111
Q
  • what are the cells activated in the inflammatory stage
A
  • neutrophils, monocytes, fibroblasts, endothelial cells
112
Q

what are the steps that characterize proliferation?

A
  1. epithelialization
  2. angiogenesis
  3. granulation tissue formation
  4. collagen deposition
113
Q

this step in proliferation is initiated by keratinocytes present on the wound edge and from dermal appendages- begins with cell detachment and mitotic division stimulated by epidermal growth factor, fibroblast growth facto, transforming growth facto 6 and multiple cytokines

A

epithelialization

114
Q

this step of proliferation includes fibroblast growth factor, platelet derived growth factor and vascular endothelial growth factor- the formation of thin walled endothelium from preexisting vessels

A

angiogenesis

115
Q

these are contraindications for _________

  • electronic devices- pacemakers
  • pregnant women- low back
  • acupuncture points of preg women
  • suspected malignancy
  • active deep vein thrombosis- thrombophlebitis
  • bleeding tissue- hemorrhagic disorder
  • osteomylitis- infected tissue
  • recent radiated tissue
  • cardiac disease
  • neck or head of seizures history
  • transcranially without training
  • reproductive organs
  • near or over eyes
  • carotid sinus
  • damaged or at risk skin
    *
A

electrical stimulation

116
Q

contraindications for _____

  • impaired sensory awareness
  • persons with cognition or communication impairments
A

TENS

117
Q

contraindications for _____

  • pregnant women
  • areas with impaired circulation
  • unstable areas due to surgery, fractures or osteoporosis
  • chest or intercostal muscles
    • lower abdomen
A

MNES

118
Q

these are applied with caution for _____

  • active epiphysis
  • persons with skin diseases
A

electrical stimulation

119
Q

these are applied with caution for ____

  • person with cognition or communication impairments- unable to give timely feedback
    • areas of impaired sensation that prevent accurate and timely feedback
A

NMES

120
Q

these are applied with caution for ____

  • areas with impaired circulation- does not exacerbate pain
  • the anterior chest wall or lower abdomen
A

TENS

121
Q

these conditions are NOT contraindicated for _____

  • intact skin overlying implants containing metal, plastic or cement
  • tissues inflamed as result of recent injury or exacerbation of a chronic inflammatory condition
A

electrical stimulation all forms

122
Q

this condition or body location is NOT contraindication for _____

  • any area unstable due to recent surgery, bone fracture or osteoorosis
    • areas around or within chronic wounds of etiology or open wounds with infection
A

TENS

123
Q

what does TENS stand for?

A

Transcutaneous electrical nerve stimulation

124
Q

subsensory level fill out

A
125
Q

sensory level

A
126
Q

motor level

A
127
Q

noxious level

A
128
Q
  • frequency: 10-250 hz
  • pulse duration: less or equal 100usec
  • amplitude: sensory level
A

parameters of TENS used for pain control - conventional

129
Q
  • frequency: <10 Hz (1-4 Hz)
  • pulse duration: 150-200 usec
  • amplitude: motor level
A

parameters of TENS used for pain control- acupuncture like

130
Q
  • frequency: 100Hz, delivered at 2 Hz
  • pulse duration: 150-200 usec
  • motor level
A

parameter of TENS used for pain control- Burst Train

131
Q
  • frequency: 100-150 Hz
  • pulse duration: 150-200 usec
  • amplitude: noxious level
A

parameters of TENS used for pain control- Brief, intense

132
Q

used for acute, subacute, chronic pain- 1 channel- symmetrical balanced biphasic, alternating current, short pulse duration, describes?

A

TENS

133
Q

refers to the magnitude of current or voltage applied by the unit- measured in milliamps or volts or millivolts

A

amplitude- intensity

134
Q

_____ is the time from the beginning of one phase to its end. measured in microseconds or milliseconds

A

phase duration

135
Q

describes the number of pulses occurring in 1 second- measured in hertz

A

frequency

136
Q

depends on treatment goals between 10-30 minutes

A

treatment time

137
Q
  • soft tissue massage
  • manual mobilizations- joints muscles, tissues
  • maipulation
  • acupressure

these describe ______ in the intervention of rehab

A

manual therapy

138
Q
  • flexibility exercise
  • strengthening exercise
  • neuromuscular re-education
  • balance coordination, proprioception
  • relaxation exercise

describes _______ in intervention rehab

A

therapeutic exercise

139
Q
  • body mechanics
  • pain relief
  • home exercise programs
  • wellness
  • risk reduction

this describes _____ of intervention rehab

A

patient education

140
Q
  • thermal heat and cold
  • mechanical compression- traction, hydrotherapy
  • acoustic- ultrasound
  • electromagnetic- electrical stimulation, laser, light therapy, diathermy

all this describe ____ of intervention in rehab

A

therapeutic modalities

141
Q

control the rate of active inflammation, limit the scope of the original injury

A

the treatment approach used during inflammation phase

142
Q

immobilization- cold modalities- compression- elevation- pulsed ultrasound- electrical stiumulation

A

typical modalities used in inflammation phase

143
Q

cryokinetics- isometric exercises- controlled ROM-CPM- proprioception- cardiovascular conditioning

A

therapeutic exercise used in the inflammation phase

144
Q

encourage the repair and replacement of damaged tissues

A

treatment approach during the proliferation phase

145
Q

compression devices- pulsed ultrasound-electrical stimulation- biofeeback- heat modalities- continuous ultrasound- traction massage

A

typical modalities used during proliferation phase

146
Q

manual therapy- passive ROM exercise- Active ROM exercise- progressive resistance exercise- proprioception exercise- functional exercise- cardiovascular conditioning

A

therapeutic exercise during the proliferation phase

147
Q

encourage tissue remodeling and alignment - along the lines of functional stress

A

treatment approach during maturation phase

148
Q

heat modalities- contiuous ultrasound- eletrical stimulation- massage

A

typical modalities used during maturation phase

149
Q

overload resistance exercises- proprioception exercises- activity specific exercises- cardiovascular conditioning

A

therapeutic exercise used during the maturation phase

150
Q

therapeutic modalities are categorized into?

A
  • `thermal
  • electromagnetic
  • mechanical
151
Q

thermal modalities include?

A
  • cryotherapy
  • thermotherapy
152
Q

the application of cold results in?

A
  • decreased tissue temp
  • decrease cell metabolism
  • decreased blood flow
153
Q

the physiological response to cold includes?

A
  • decreased bleeding
  • decreased formation of acute inflammation
  • decreased pain
154
Q

methods of cryotherapy application include?

A
  • ice
  • cold water
  • cold gel filled packs
  • vapocoolants
155
Q

factors that determine method of cryotherapy application include?

A
  • size of the affected area
  • depth of the tissues to be treated
  • patients tolerance to cold
  • site of application
156
Q

the application of heat results

A
  • increased tissue temp
  • increased tissue metabolism
  • increased blood flow
157
Q

the phsyiological responses of thermotherapy include?

A
  • tissue healing
  • relaxation of skeletal muscles
  • decreased spasms
  • increased blood flow
  • prepare soft tissues for stretcing mobilization and exercise
158
Q

methods of application for thermotherapy include?

A
  • warm water
  • heat packs
  • light-infrared sauna
  • sound-continuous ultrasound
  • eletromagnetic energies- shortwave diathermy
159
Q

superficial heat is up to _____ cm and includes?

A
  • 3 cm
  • moist heat pack
  • paraffin wax bath
  • fluidotherapy
  • warm whirlpool
  • microwavable gel packs
  • air-activated heat wraps
  • electric heating pads
160
Q

deep heat is up to _____ cm and includes?

A
  • 5cm
  • continuous ultrasound
  • continuous shortwave diathermy
161
Q

physiological response to electrotherapy includes?

A
  • decreased pain
  • decreased muscle spasms
  • facilitating neuromuscular reeducation
  • augmenting ROM
  • promoting tissue and wound healing
  • reducint edema
  • increasing local blood flow
  • delivering medicinal ions transdermally
162
Q

fundamental to most applicatios of electrical stimulation is ____ of the ____ nerves

A

depolarization

peripheral nerves

163
Q

most widely recognized application of electrotherapy to reduce pain is?

A

TENS

164
Q
A

summer 2021 (4 decks)

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