Theory

Question 1

Describe the Gunn Neuropathic Model

Answer 1

the role of compression on muscle trigger points and how a sensitization can manifest (dystrophic nerve)

Question 2

What is the cycle of dysfunction proposed by Gunn

Answer 2

spondylosis, compression of peripheral nerves, denervation supersensitivity, muscle banding / trigger points, increased nerve irritation, continued denervation supersensitivity

Question 3

Describe energy crisis theory and motor end plate hypothesis as it pertains to trigger points

Answer 3

consider the chemical causes of prolonged contraction. The energy crisis theory considers the role of calcium, and the motor end plate hypothesis considers the role of acetyolcholine

Question 4

2 general recepotros in the body

Answer 4

Exteroreceptors collect information from outside the body, and enteroreceptors collect information from within our body.

Question 5

factors influencing nervous system

Answer 5

pain, injury, stress, sleep, nutrition, emotion, exercise load, enviormental stressors

Question 6

Are there reflex loops in periphealr and visceral nervouse systems

Answer 6

Yes the peripheral nervous symptoms involve muscles for reflex loops, and visceral internal organs.

Question 7

Differentiate between thes omatic afferen tinformation and visceral afferent information

Answer 7

The somatic nervous systems carries afferent sensory information from skin, muscles and joints. The Visceral nervous system includes afferent information from organ and blood vessels.

Question 8

Describe the modulation of pain an on/off mechanism?Explain

Answer 8

The body can inhibit and facilitate pain. The modulation system is not an on and off system because it considers the input. It may prioritize and evaluate information - it may consider danger, and receive input from other systems of the body (i.e limbic) to modulate pain.

Question 9

Nerve layers deepest to superficial

Answer 9

Epineurium, perinuerium, endoneurium

Question 10

What are some distinguishing characteristics of each layer

Answer 10

Endo - more susceptible to pressure. Peri - risk of punctures. Epi - dense connective tissue

Question 11

What determines if a nerve fires or transmits an impulse?

Answer 11

If excitatory potential exceed inhibitory potential

Question 12

List the nerves in order of fasted to slowest speed of impulse conduction

Answer 12

Mylenated (A Alpha, B Beta, A Delta ) Unmyelinated (C fibers)

Question 13

What is the difference in type of pain and modality sensed between A delta and C- Fibers?

Answer 13

A delta are intense signal conducting for fast nociceptive pain, damaging temperature and light mechanical deformation.

C fibers are slower adaptive receptors, sensations include warm, secondary burning to pain and muscle burn.

Question 14

What are the three types of pain and their broad descriptions according to Wall?

Answer 14

Type 1 (Nociceptive, immediate acute pain), Type II (Inflammatory, biochemical pain), Type III (Chronic, neuropathic)

Question 15

What are the time responses for the different types of pain?

Answer 15

Type 1 - immediate. Type II within 48 hours, Type III > 3 months persists.

Question 16

What is the description of the quality of pain for each type?

Answer 16

Type I (sharp, stabbing, throbbing), Type II (Acute, throb), Type III (Variable)

Question 17

What behaviours are associated with each type of pain?

Answer 17

Type I (fight or flight), Type II (concern, anxiety, care seeking), Type III (depression, introversion, resistant to treatment)

Question 18

How long does the maturation phase of wound healing take?

Answer 18

21 days to 3+ years

Question 19

After the maturation phase of wound healing is the tissue as strong as it was before?

Answer 19

No, it can be 20% weaker than original tissue

Question 20

Describe the gate control theory of pain

Answer 20

The gate control theory describes how different types signals can interfere with others. For example, a A beta fibers can inbibit the effects of fast pain and slow pain.

Question 21

What tissues in the body can develop denervation supersensitivity ?

Answer 21

Muscles, glands, vessels, organs, CNS

Question 22

According to Cannon and Rosenbluth, what occurs when a nerve is injured?

Answer 22

It can result in super sensitivity

Question 23

Describe the types of supersensitivity that can develop

Answer 23

Normal (normal response),
super duration (time course increases),
hyper-excitability (threshold of stimulating is lower),
increased susceptibility (threshold of stimulus is lower than previous, non-noxious or noxious),
super reactivity (capacity of tissue to respond is augmented)

Question 24

What are the four main causes of neuropathy?

Answer 24

Mechanical, chemical, chemical (exogenous source), disease process

Question 25

Which nerve fibers are the most susceptible to compression?

Answer 25

Large diameter nerves

Question 26

What are the three major categories of compression to motor neurons according to Seddan?

Answer 26

Neuropraxia, axontmesis, neurotmesis

Question 27

Which of the three has signs and symptoms that are similar to neuropathic signs and symptoms?

Answer 27

Neuropraxia

Question 28

For each of the following, list one specific change that occurs in a neuropathic state: * Histopathology - * Vascular - * Neural Tissue * Muscular - * Biochemical * Connective Tissue Changes - * Autonomic Nervous system - * Movement/Postural Dysfunction

Answer 28

* Histopathology - collagen changes from Type I = Type III (not as strong of connective tissue) * Vascular - lipid deposits and thrombi are observed * Neural Tissue - decreased threshold to nerve firing * Muscular - not providing appropriate information to muscle for firing (shortened muscle syndrome, trigger points) * Biochemical - elevated hydrogen (trigger points) * Connective Tissue Changes - dystrophic changes at bone, tendon ligament leading to tendinitis, bone spurs, arthritis etc. * Autonomic Nervous system - super sensitized nerves, peau d’orange. Hair loss. * Movement/Postural Dysfunction- wake and shortened muscles lead to alterations in biomechanics

Question 29

Define neuropathy:

Answer 29

Disease or injury to one or more nerves leading to nerve function impairement

Question 30

Define traditional radiculopathy -

Answer 30

Often at spinal nerve root with radicular pain - weak, numb. lack of ongoing nociceptive input that are persistent at 12 weeks post injury

Question 31

What are the signs and symptoms of neuropathy?

Answer 31

Postural imbalance, movement dysfunction, decreased ROM, neural changes, autonomic changes, muscles with trigger points ,tenonitis, osteoarthritis or bony changes

Question 32

List 3 potential peripheral and 2 central mechanisms for the development of neuropathic dysfunction

Answer 32

Peripheral - ectopic conduction, ephatic conduction, alteration in ion channel Central - spinal cord reorganization, central sensitization

Question 33

What are to potential mechanisms that would describe the effect of needling immediately and over a longer period?

Answer 33

Direct and reflex stimulation to the trigger point causing an immediate contract relax reflex via spinal reflex pathway, Micro trauma from the needle causing inflammatory process of injury. Over longer period of time this allows increased ROM.

Question 34

List the absolute contraindications to needling

Answer 34

Patient factors (needle junkie, phobia), Therapist factors (confidence, knowledge), infection, active tumour, compromised immune symptom, near surgical insite or on side of lymph node removal, inappropriate equipment

Question 35

What are the relative contraindications to needling?

Answer 35

Acute trauma, active autoimmune disease, over impacts, blood thinners, children, allergies to medal, heart valve replacement

Question 36

What are precautions with needling?

Answer 36

severe allodynia anxiety language barriers, cognitive impairement, Vascular disease, diabetes,

Question 37

What is the minimum amount of time you should wait before needling in any area that communicates with a surgical site? What about the local area of surgery?

Answer 37

Needling near surgical site within 3 months is contraindicated. Post surgical in any tissue for 6 weeks is a relative contraindication. Post surgical in local area for 3 months is a relative contraindication.

Question 38

Describe sterile technique for needle application

Answer 38

Wash hands with soap, use latex gloves, wash the area, sterolize gloves after palpating area to needle, if needle touches skin throw it out, place needle and cotton swab after you have pressed it on wound in sharps / biohazard container

Question 39

What should you do if you receive a needle stick injury?

Answer 39

Dispose of needle, remove gloves and contaminated clothes, wash wound with soap and water, go to emergency for testing and treatment protocol

Question 40

. List 10 different potential side effects of needling

Answer 40

Bruising Bleeding Pain Soreness Dizzy Nausea Sweating Feeling faint Fatigue Broken needle Pnueomthoax Infection

Question 41

Which post needle complications require hospital admission?

Answer 41

Pnuemothorax

Question 42

List the clinical signs and symptoms of pneumothorax

Answer 42

Shortness of breath, sudden sharp chest pain, weak rapid pulse, dry hacking cough, shoulder pain, patient finds sitting up right most comfortable position

Question 43

46. What are the signs and symptoms of a vasovagal reaction?

Answer 43

Pale skin, feeling swarm or cold and clammy, yawning, blurred vision

Question 44

List the requirements to use a needle as a treatment modality

Answer 44

No contraindications, appropriate patient, you have time and equipment, you can test - retest for impact, you have screened sensitivity or nervous system dysfunction, you have completed neuropathic scan, signs of nerve root involvement that innervate tight bands, anatomically and movement wise it makes sense, you have considered less invasive techniques.

Question 45

What must you consider when selecting your patient for potential needling?

Answer 45

The diagnosis, medical condition, if the patient understands, communicates, has capacity to lay still, and give informed consent. If you are in a safe application area.

Question 46

CLEAN NEEDLING GUIDELINES

Answer 46

wash hands before and after each patient environment prepared prior - should include all required equipment, appropriate lighting, appropriate space sharps container that is open for needs disposal, pliers 3. Adequately expose the area 4. Pgloves and sterilize with isopropyl alcohol > 70 Sterilize area allow to dry 6. Open sterile needle packet to expose the needle and remove the tab 7. With non needle hand landmark appropriately and palpate the muscle to be needled; then bracket this muscle Tap in needle firmly with index finger 2. Remove guide tube slowly and hold only the needles handle. If the shaft touches you or the skin as it bends remove and dispose of the needle in the sharps container 3. Re sheath needle if required by inserting handle first into the guide tube 4. Place the needle in the sharps container once completed 5. Apply direct pressure with cotton swab, 6. Dispose of tissue/swab into sharps container 8. Remove gloves enclosing any blood borne tissues and guide tubes and place in disposal bin

Question 47

Define radiculopathy/radiculoneuropathy according to the FHE definition

Answer 47

Compression, pressure and/or any combination of tri-planar load to a nerve can alter its function. If left unaddressed, mechanical insult can create a dystrophic state within the nerve, those nerves that communicate with it and its target tissues.