Stages of Tissue Healing and Interventions - Class 6

Question 1

stages of tissue healing

Answer 1

acute stage

subacute phase

chronic stage

Question 2

acute stage

Answer 2

inflammatory response

Question 3

subacute phase

Answer 3

proliferation

repair

healing

Question 4

chronic stage

Answer 4

maturation and remodeling

Question 5

acute stage consists of

Answer 5

vascular changes

exudation of cells and chemicals

clot formation

phagocytosis/neutralization of irritants

early fibroblastic activity

Question 6

what is present during the acute pahse

Answer 6

signs of inflammation

Question 7

signs of inflammation

Answer 7

swelling

redness

heat

pain at rest

loss of fxn

Question 8

acute phase –> ROM

Answer 8

painful w/ guarding before the completion of the range

Question 9

what is pain d/t in the acute phase

Answer 9

altered chemical state irritating nerve endings

increased tissue tension

guarding

Question 10

why is there pain in the acute phase

Answer 10

body’s way of protecting the injury

Question 11

how long does the acute phase last

Answer 11

4-6 days

Question 12

goals and interventions of acute stage

Answer 12

protection phase

control effects of inflammation

manage pain

prevent negative effects of rest

education

general movement

pain…

Question 13

prevent negative effects of rest

Answer 13

nondestructive movement

PROM

massage

muscle setting

Question 14

education

Answer 14

on expected duration

what they can do

what to expect

Question 15

general movement is

Answer 15

beneficial

Question 16

pain

Answer 16

during movement in this phase is generally ill advised

but at low levels may be ok

Question 17

subacute phase involves

Answer 17

removal of noxious stimuli

growth of capillary beds into area

collagen formation

granulation tissue resulting in very tenuous, easily injured tissue

Question 18

when does inflammation decrease

Answer 18

2-4 days after injury

colt begins to resolve

repair begins

Question 19

how long is the subacute phase

Answer 19

14-21 days after injury

but can last 6 weeks

Question 20

defining characteristic of the subacute phase

Answer 20

synthesis and deposition of collagen

Question 21

what is there a significant increase in –> subacute phase

Answer 21

presence and activity of fibroblasts

myofibroblastic activity begins around day 5 –> resulting in scar shrinkage

Question 22

connective tissue –> subacute

Answer 22

immature

thin and unorganized

extremely fragile

Question 23

tensile loading –> subacute

Answer 23

appropriate tensile loading can stimulate growth and alignment

Question 24

subacute phase goals and interventions

Answer 24

controlled motion phase

develop a mobile scar

promote healing

continue to educate

asses response and sxs

gradually transition into active strengthening and endurance exercise

can implement stretching

be on the lookout for signs of excessive stretch

Question 25

develop a mobile scar --> subacute

Answer 25

selective stretching/mobilization

Question 26

promote healing --> subacute

Answer 26

nondestructive active, resistive, open and closed chain stabilization exercise muscular endurance cardiopulmonary exercise to increase circulation

Question 27

continue to educate --> subacute

Answer 27

about expectation encourage return to normal activities that do not exacerbate sxs begin more involved HEP

Question 28

assess response and sxs --> subacute

Answer 28

generally slow progression

Question 29

gradually transition into active strengthening and endurance exercise --> subacute

Answer 29

submax isometrics AROM building endurance w/ repetition/low intensity exercise protected weight bearing exercise

Question 30

what should we avoid in the subacute phase

Answer 30

heavy eccentrics high resistance exercises that may overstress the area

Question 31

can implement stretching --> subacute

Answer 31

to minimize decreased flexibility help with alignment of developing scar

Question 32

signs of excessive stretch (1)--> subacute phase

Answer 32

soreness that persists longer than 24 hrs after exercise increased intensity and earlier onset of pain progressively increased feelings of stiffness/decrease ROM over several sessions

Question 33

signs of excessive stretch (2)--> subacute phase

Answer 33

swelling, redness, warmth in affected tissue progressive weakness over several sessions decreased fxnal use of involved body part

Question 34

chronic stage involves

Answer 34

maturation of connective tissue contracture of scar tissue remolding of scar collagen aligns to physical stress

Question 35

when is scar retraction typically complete

Answer 35

after 21 days scar stops decreasing in size

Question 36

when does the process of maturation begin

Answer 36

late subacute phase persists for several months

Question 37

what happens to the collagen fibers in the maturation phase

Answer 37

thicken and reorient based on physical stress placed through connective tissue

Question 38

what is remodeling time influenced by

Answer 38

factors that affect the density and activity of fibroblasts

Question 39

factors that affect the density and activity of fibroblasts --> chronic stage

Answer 39

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

Question 40

healing time depends on

Answer 40

size of injured structure degree of injury/pathology healing with increasing tensile quality

Question 41

healing may occur for

Answer 41

12-18 months

Question 42

what happens to immature collagen fibers --> chronic

Answer 42

adhere to surrounding tissue can be easily remodeled through physical stress for 10 weeks after the injury

Question 43

what happens if the area isnt properly stressed --> chronic

Answer 43

collagen will begin to adhere to surrounding tissue forming a restricting scar

Question 44

what happens at 14 weeks --> chronic

Answer 44

scar is unresponsive to remodeling required adaptive lengthening of the surrounding tissue or surgical release

Question 45

chronic stage goals and intervention

Answer 45

return to fxn phase increase tensile quality of scar develop fxnal independence educate the pt lean into progressive resistance exercises may need to isolate certain muscle/muscle groups transition into high demand activities that stimulate specific tasks

Question 46

increase tensile quality of the scar --> chronic

Answer 46

through progressive strengthening and endurance exercise

Question 47

develop fnxal independence --> chronic

Answer 47

through fxnal exercise and specificity drills

Question 48

educate the pt

Answer 48

safe progression of resistance exercises and how to monitor for signs of excessive stretch est clear guidelines/criteria on return to affected activities recommend progressions or modifications of exercises recommend modifications to activities as necessary

Question 49

isolate certain muscle/muscle groups --> chronic

Answer 49

b/c of inhibition or learned disuse