PTH 118 Exam 1 (need pp ch 3,4)
Fracture management and healing objectives for bone healing
Approximate bone fragments Maintain alignment Preserve and restore function
Complications that can occur with bone healing:
Delayed union Nonunion Malunion
Adverse reactions of non-narcotic analgesics
Drowsiness Change in balance Shakiness Swelling
Adverse reactions of narcotic analgesics
Drowsiness Lightheaded Blurred vision Nausea/upset stomach Dry mouth, constipation
Articular cartilage characteristics & function:
Frictionless 2 to 4 mm thick (generally) Durable (resistant to wear) Able to dissipate compressive load Joint lubrication Load bearing Joint stability
Tissue healing, Healing by: tertiary intention
Granulation fills the gap with epithelial growth slow
"What is the primary goal in a physical therapy assessment of a patient with pain"?
Identifying biological, psychological, and social factors that may contribute to the patient's experience of chronic pain.
Rehabilitation for bone healing to encourage:
Improved circulation Fragment approximation Promote motion to immobilized parts Stimulate the piezoelectric effects
fight-or-flight" reaction involves numerous body systems and typically includes:
Increased heart rate and sweating Expansion of the bronchioles (small airways) Dilation of the pupils Shunting of blood from the skin and digestive tract to the muscles and brain
Cartilage is healed by
Increased vascular supply to lesion Surgery - femoral and retropatellar arthroscopic abrasion to smooth the surface, stimulate inflammatory process & subchondral bone bleeding Chondrocytes communication with the wound
Classification of bone healing
Injury site Configuration of injury Relationship of fracture to the environment Pediatric fractures - Salter-Harris (growth plate fracture) Osteoporosis is a common cause of pathologic fractures in geriatrics
Injury to cartilage leads to:
Joint instability Immobilization Repetitive overload (stress) Non-weight bearing (leads to degeneration and loss of proteoglycan) (protein)
Normal bone growth, remodeling and repair are influenced by:
Motion Stress (Wolff's Law) Muscular contraction Piezoelectric (ES) effect
During early phase 3 of healing, active stress, muscular contractions (sub-maximal ISOM or endurance exercises) and joint motion (PROM) allows collagen to:
Organize Become stronger Become functional
(AKA Fibroblastic, Repair, Regeneration Phase): Involves the revascularization and rebuilding of tissues Growth factor beta: for collagen production (Type III). Fibroblast (Scar formation) growth factors: for cellular proliferation, differentiation migration, matrix deposition phases of wound healing. Hepatocyte growth factor: for antifibrotic activity prevents excessive fibrous depositions. Osteogenic growth factors: for bone repair.
Phase II: Proliferation
Pain can be a sign of:
Physical problems Physiological (chemical processes) Psychological dysfunction (mental and emotional state)
this response to tissue healing is Tissue destruction associated with traumatic force can't change amount of initial damage. Prostaglandins are produced by nearly every cell in the body:
Primary Response:
Goals of Phase 1
Protect Localize Decrease injurious agents Prepare for healing and repair
For ligament injuries, Surgery During the early protection phase with early motion (following immobilization) is to:
Reduce bloody effusion within the joint Increase connective tissue strength Inhibit adhesions
Mechanothermal nociceptors
Responds to noxious heat. A-delta fibers (fast) Sensations are well localized with a "pricking" sensation
NMES in conjunction with ISOM contractions during immobilization may:
Retard disuse atrophy Minimize strength loss Reduce the loss of succinic dehydrogenase
The most basic premise behind Melzack and Wall's gate control theory of pain is that:
Sensory stimuli can inhibit painful stimuli from reaching the brain. Target the perception of pain is considered a secondary pain control approach.
Tissue healing, Healing by: second intention
The edges are separated, granulation tissue develops to fill the gap with epithelial growing over the granulated tissue
Cartilage, Intraarticular tears can occur from:
Twisting Torque Deceleration Compression
Untreated sprains are composed primarily of:
Type III collagen Biomechanically inferior to ligaments treated with mobilization Generally not healed even 40 weeks after injury Can lead to ligament atrophy and reduced strength
Adverse effects of pain
Weakness Decreased range of motion Fatigue Insomnia Increased irritability Anxiety Depression Decreased appetite Emotional distress
Classic treatment of phase 1 (first 24-72hrs)
(RICE) Rest, ice, compression, elevation
The neurons from the Central Pathway that release neurotransmitters are: (they all reduce the perception of pain by bonding to pain receptor sites)
- Norepinephrine - Serotonin - Block pain signals - Enkephalins
Polymodal nociceptors
- Responds to noxious heat and irritant chemicals - C-fibers (slow) - Sensation are poorly localized with a due aching burning sensation
Nociceptors
- Specialized receptors signal actual or potential tissue damage. - "Nociception is the neural process of encoding and processing noxious stimuli"
For the PTA, pain helps determine the:
- location of the injury - its behavior in determining the stage of healing - impact on patient function
The release of endogenous pain chemical mediators include:
- potassium - serotonin (5-HT) - Bradykinin - Histamine (released by mast cells) - prostaglandins - leukotrienes - Substance P
Most common site for Osteoporosis
- vertebral body compression fracture
Nociceptors are the terminal portions of two types of afferent neurons:
-A-Delta - C-fibers
Contraindications for Heat modalities
-Circulatory impairment -Area of malignancy -Acute musculoskeletal trauma -Arterial disease -Bleeding or hemorrhage -Sensory impairment -Thrombophlebitis
Tendon injuries that require surgical repair are best treated with:
-Limited immobilization -Gentile, protected ROM -Appropriate exercise
Therapeutic heat or cold is delivered to the target tissue by all of the following mechanisms except? Evaporation Conversion Radiation None of the above; all are mechanisms for the delivery of therapeutic heat.
-None of the above; all are mechanisms for the delivery of therapeutic heat.
Indications fro Heat modalities
-Pain control -Chronic inflammatory conditions -Trigger point -Tissue healing -Muscle spasm -Decreased ROM -Desensitization
the 3 steps or stages of the proliferation phase (Phase 2)
-Resolution (Epithelization or granulation) -Regeneration (Wound contraction) -Repair (collagen production)
Scar is fragile at first, resurfacing of the infrastructures of the wound occurs with epithelial tissue that is _____ cell layer thick
1 cell layer
Stages of EBP Implementation
1. Identify a problem or area of uncertainty. 2. Formulate a concise clinical question from a specific patient problem. 3. Search the literature for relevant clinical articles. 4. Critically appraise the identified evidence for its validity and usefulness. 5. Implement relevant findings in clinical practice. 6. Assess the outcomes of the selected action. 7. Summarize findings for future reference.
Goals of Medical management for INJURIES:
1. Resolve the underlying pathology causing the pain. 2. Modifying the patient's perception of the discomfort (self-management). 3. Maximizing function within the limitations imposed by the source of pain. 4. Resolution of the underlying condition causing the pain (i.e. poor posture) and include exercising.
Medical management of PAIN goals: (4)
1. Resolve the underlying pathology causing the pain. 2. Modifying the patient's perception of the discomfort (self-management). 3. Maximizing function within the limitations imposed by the source of pain. 4. Resolution of the underlying condition causing the pain (i.e. poor posture) and include exercising.
The MOST desirable (highest) level of evidence from available options to the least desirable (lowest) level of evidence:
1. Systematic review 2. Randomized controlled trial 3. Cohort study 4. Case control study 5. Case report
Controlled cold unit
10-25C (50-77F)
Ideal temp for fluidotherapy?
100 F to 118F (38.8 to 47.8)C
Air activated heat wraps?
104F (40)C
Ideal temp for paraffin?
1130 F to 122F (47-54.4)C
Ideal temp for hydrocollator packs?
158-167F (71-79)C
Ideal temp for cold packs?
25F (-5)C
How long does phase 2 last (proliferation)
3-20 days
Physiological changes in response to heat application vary according to the intensity of the agent, the duration of application, and the area being treated. Hyperemia is a sign of vigorous heating. At what tissue temperature would there be irreversible tissue damage due to protein being denatured? 45oC (113oF) 43oC (109oF) 37oC (98.6oF) 38oC (100oF)
45oC (113oF)
Cold/cool water bath
50-65F
Cold or Ice baths
55-64F (13-18)C
Scar tissue is _______ as strong as the tissue it replaces, which is one of the underlying reasons that the
70%
The adult skeleton is comprised of __% compact and cortical bone
80%
"_____________ that is symmetrical around its vertical axis with the values tending to cluster around the mean". • The mean, median, and mode have the same value. • The curve has no boundaries and only a small fraction of the values fall outside of three standard deviations above or below the mean. • Approximately 68% of all values fall within one standard deviation above or below the mean. • Approximately 95% of all values fall within two standard deviation above or below the mean. • Approximately 99% of all values fall within three standard deviation above or below the mean.
A bell-shaped curve
Which of the following best describes a "peer-reviewed journal"? A journal that your co-worker was able to read first A journal in which the articles have been evaluated for credibility and relevance by experts after publication A journal in which the articles have been evaluated for credibility and relevance by experts prior to publication
A journal in which the articles have been evaluated for credibility and relevance by experts prior to publication
What is the difference between a visual analog scale and a numeric pain rating scale? A visual analog scale is less subjective than a numeric pain rating scale, making it more difficult for a patient to remember prior ratings. A visual analog scale is more subjective than a numeric pain rating scale, making it more difficult for a patient to remember prior ratings. A numeric pain rating scale is more commonly used than a visual analog scale.
A visual analog scale is less subjective than a numeric pain rating scale, making it more difficult for a patient to remember prior ratings.
- transmit detailed information rapidly form the peripheral cutaneous structures Transmit pain signals that are sharp and localized
A-delta
These fibers transmit discriminative touch stimuli from the skin: Sensitive to crude touch, pain, and temperature. Transmit faster Pain sharp, stabbing, tingling, prickly Quick onset, lasts shorter time, localized Not affected by opiates
A-delta fibers
Assessment of the integument includes characteristics such as color, continuity, and temperature. Which of the following statements is most accurate? -Skin color is not based upon the amount of hemoglobin present. -Elevated skin temperature is indicative of an infection. -Acute burns to the skin elevate skin temperature.
Acute burns to the skin elevate skin temperature.
- is associated with tissue damage or the threat of such damage and typically resolves once the tissue heals or the threat resolves It is often associated with physiological signs of distress, such as sweating, pallor, nausea, and heart rate changes
Acute pain
When sensory information reaches the brain, the information is integrated and interpreted along with information about the temperature of the blood circulating through the hypothalamus. Which of the following mechanisms regulates temperature? Vasodilation or vasoconstriction of blood vessels Shivering to maintain heat Sweating to lose heat All of the above are examples of temperature regulation.
All of the above are examples of temperature regulation.:
Which of the following organizations includes the use of evidence-based practice in its "Vision 2020"? -Commission on Accreditation of Physical Therapy Education (CAPTE) -American Physical Therapy Association (APTA) -Federation of State Boards of Physical Therapy (FSBPT) -Medicare
American Physical Therapy Association (APTA)
Metabolic rate changes in association with changes in tissue temperature. Which of the following statements is most accurate? An increase in metabolic rate delays tissue healing. An increase in metabolic rate may be used advantageously to facilitate tissue healing. An increase in metabolic rate may adversely affect oxygen consumption and delay tissue healing.
An increase in metabolic rate may be used advantageously to facilitate tissue healing.
- the absence of pain or noxious stimulation
Analgesia
- loss of sensation, usually by damage to a nerve or receptor. Lidocaine is an example of a pain-decreasing medication which temporarily blocks nerve conduction, thus resulting in the loss of sensation.
Anesthesia
These nerve fibers send their impulses to the dorsal horn of the spinal cord carried to the thalamus via the spinothalamic tracts the nerve signal is then projected to the sensory cortex interpreted and become a conscience pain sensation. Which type of pathway is this (Ascending or descending)
Ascending pathway
After reading a patient's evaluation, you determine that exercises to strengthen the vastus medialis muscle would be beneficial. You ask yourself, "What exercises would promote maximum firing of vastus medialis muscle fibers?" This is an example of which of the following steps of evidence-based practice? -Ask -Acquire -Appraise -Apply
Ask
When evaluating the design of a research study, we can utilize the hierarchy of evidence. With which of the following factors does the hierarchy rank research designs?
Bias
in the central pathway, The peripheral first-order _______________enter the gray matter of the spinal cord.
C and A-delta afferents
- transmit information from deeper tissues (joints, viscera) and do so more slowly that A-delta fibers Transmit dull, aching and diffuse pain signals
C-fibers
These fibers are coming from pain receptors (Afferent fibers) Slow transmitting. Pain usually dull, throbbing, aching and harder to localize. Associated with increased perspiration, HR and BP, nausea. Best reduced by opiates.
C-fibers
Muscle guarding (spasm)
Causes - Edema formation (swelling) & ischemia
-The peripheral first-order C and A-delta afferents enter the gray matter of the spinal cord. -The C and A-delta fibers synapse, either directly or via interneurons, with second-order neurons (AKA transmission or T-cells) in the superficial dorsal horn of the gray matter (substantia gelatinosa; Lamina III ). -T-cells make local connections within the spinal cord, either with efferent neurons (reflexes) or with afferent neurons (project to the cortex). -Inhibitory interneurons in the substantia gelatinosa are activated by input from large-diameter, myelinated, low threshold sensory neurons (A-beta) that respond to non-painful stimuli.
Central Pathway:
- is any pain persisting more than a specified length of time, such as 3 or 6 months. A second definition of this type is pain that is long-lasting, persistent, and of sufficient duration and intensity to adversely affect a patient's well-being, function, and quality of life. It often is not well defined or easily localized because the nociceptors commonly transmit stimuli from the nerve root through several different segments.
Chronic pain
- is pain that exists when individuals have developed extensive pain behaviors such as: Preoccupation with pain Passive approach to health care Significant life disruption Feelings of isolation Doctor shopping
Chronic pain syndrome
Conversion refers to the temperature change that results from energy transformed from one form to another, such as the conversion from mechanical or electrical energy to heat. Which of the following examples of a physical agent modality represents a form of heat by conversion? Fluidotherapy Exposure to an infrared lamp Continuous ultrasound Hot pack application
Continuous ultrasound
Convective heat sources differ from radiant heat sources in what way? Convective heat sources rely on the movement of air, matter, or liquid around or past the body, and radiant heat sources do not require movement of anything. Convective heat sources do not require movement, and radiant heat sources rely on the movement of air, matter, or liquid around or past a body. Radiant heat sources heat by conduction, and convective heat sources use fans. Radiant sources heat or cool, and convective sources only cool.
Convective heat sources rely on the movement of air, matter, or liquid around or past the body, and radiant heat sources do not require movement of anything.
• This type of study examines the frequency and characteristics of a disease or specific condition in a population at a particular point in time "snapshot". • This type of research is often used to assess the prevalence of acute or chronic conditions in a population.
Cross-Sectional Study:
(Inhibitory pathway): Descending modulation of pain perception is thought to block pain signal transmission in the dorsal horn of the spinal cord. Sensory-discriminative is a dimension of pain perception localize the source and type of pain. Non-painful sensory stimulus (transmitted via A-beta) is also thought to block pain signal transmission in the dorsal horn.
Descending pathway
• Recording, analyzing and interpreting conditions that exist. • Involves some type of comparison or contrast and attempts to discover relationships between existing and non-manipulated variables.
Descriptive Research:
Which of the following terms is used to denote the disease or syndrome? It is derived from the evaluation of the examination results (according to the Guide to Physical Therapist Practice, 2nd edition). Intervention Examination Evaluation Diagnosis
Diagnosis
What must take place between the physical agent and the patient's skin if conduction is the method of thermal exchange? An extended period of exposure between the heat agent and the skin Direct contact between the thermal agent and the patient's skin Sufficient movement of air between the thermal agent and the patient's skin
Direct contact between the thermal agent and the patient's skin
Body produces morphine-like peptides (endogenous opiates) which inhibits the transmission of pain. Intense exercise, acupuncture, intense pain are types of stimuli that would potentially result in the liberation of endogenous opiates (Endorphins). In the pain control theories, a secondary pain control approach is to Target the perception of pain.
Endogenous Opiate Theory:
Any of a group of peptide hormones that bind to opiate receptors and are found mainly in the brain. Endorphins reduce the sensation of pain and affect emotions for a longer duration.
Endorphins
Either of two polypeptides that bind to morphine receptors in the central nervous system and have opioid properties of relatively short duration.
Enkephalins
Which of the following terms means "a dynamic process in which the physical therapist makes clinical judgments based on data gathered during the examination" (according to the Guide to Physical Therapist Practice, 2nd edition)? Intervention Examination Evaluation Diagnosis
Evaluation
The process of obtaining a history, performing relevant systems reviews, and selecting and administering specific tests and measures is the definition of which of the following terms (according to the Guide to Physical Therapist Practice, 2nd edition)? Intervention Examination Evaluation Diagnosi
Examination
Which of the following research designs contains a control group? Experimental Quasi-experimental Non-experimental Case study
Experimental
• A description of what will result when certain variables are carefully controlled or manipulated. •The focus is on variable relationships.
Experimental Research:
The proliferative phase of healing involves the revascularization and rebuilding of tissues. Which of the following is most accurate in describing tissues during this stage of healing? Fragile Hot Bulky Smooth
Fragile
Stimulation of A-beta (large diameter, myelinated, non-nociceptors) sensory (afferent) fibers causes inhibition of T-cells (interneurons) which: Closes the "gate" to the cerebral cortex thus decreases the sensation of pain.
Gate Control Theory:
Which of the following endogenous substances is NOT released into an injured area as a normal response to injury? Potassium Serotonin Histamine Glucose
Glucose
Partial tearing of ligament fibers with resultant moderate joint laxity is defined as a _____
Grade II sprain
__________ are the most common types of ligament sprains
Grades I & II
Type of research that: • Investing, recording, analyzing and interpreting the events of the past for the purpose of discovering generalizations that are helpful in understanding the past, the present, and to limited extent, anticipating the future.
Historical Research:
Defines pain that is produced from a normally non-painful stimulus.
Hyperesthesia
GOALS for bone healing by therapist
Improve patient fitness Minimize muscle atrophy Protect healing structures Teach safe and effective gait and transfers
Temperature regulation occurs to maintain homeostasis through the interaction of local and central neural mechanisms. Where in the brain is this information processed? In the hypothalamus In the thalamus In the cortex
In the hypothalamus
_________ is the bodies response to injury
Inflammation
Vascularized tissue responds to injury with a series of events that are referred to as inflammation and repair. Which of the following statements is least accurate in describing the purpose of inflammation? Inflammation results in immobilization of the area. Inflammation results in preparation of the area for repair. Inflammation results in dysfunction and must be avoided.
Inflammation results in dysfunction and must be avoided.
Tissue healing (wound healing) Healing by: first intention
Initial union of the edges of a wound, progressing to complete healing without granulation
Which of the following stimuli could result in the liberation of endogenous opiates?
Intense pain
Which of the following terms means "the purposeful and skilled interaction of the physical therapist with the patient/client by using various physical therapy methods and techniques to produce changes in the condition that are consistent with the diagnosis and prognosis" (according to the Guide to Physical Therapist Practice, 2nd edition)? Intervention Examination Evaluation Diagnosis
Intervention
Blanching is one of the responses of the skin that is helpful in determining whether or not the circulation is impaired to an area. What is the significance of blanching in the treatment area? It determines the amount of hemoglobin present in the injured tissue. It indicates the response of applied pressure to the skin, indicating circulation. It indicates the absence or presence of capillary buds in the injured tissue.
It indicates the response of applied pressure to the skin, indicating circulation.
While reading an advertisement in the paper, you notice that the local hospital is looking for participants in a research study. They are looking for people who have knee pain. The advertisement states that if the person has had knee surgery of any type within the past six months that they will not be considered for participation. Which of the following is considered the inclusion criteria for this study?
Knee pain
Memories of past experiences are a component that creates one's "pain filter."
Limbic system:
Axons in _________ tract run up and down for one or two spinal cord segments before they penetrate the gray matter of the dorsal horn.
Lissauer's tract
-is pain associated with cance
Malignant pain
Measures perception of pain. Body diagram for pain location. Word descriptors for pain quality. Pattern of pain. Advantages of this assessment is Quantitative and Qualitative information of pain
McGill Pain Questionnaire (MPQ)
Spotty patches of erythema following the application of thermal agents are referred to as mottling of the skin. What is the significance of mottling? Mottling is a normal response to the application of heat. Mottling is an abnormal response to the application of cold. Mottling is a potential warning sign that the underlying tissue may not be able to effectively respond to thermal agents.
Mottling is a potential warning sign that the underlying tissue may not be able to effectively respond to thermal agents.
- Opiated to treat or prevent severe pain - Acts in the brain to depress the brains perception of pain (physically addictive): Lortab - hydrocodone/APAP Dilaudid - hydromorphone Morphine Oxycontin - oxycodone Percocet - oxycodone
Narcotic analgesics
- is pain that arises from actual or threatened damage to non- neural tissue and is due to the activation of pain receptors, nociceptor
Nociceptive pain
- free nerve endings present in most types of tissue that are activated by thermal, chemical or mechanical stimuli.
Nociceptors
- to treat and prevent muscle and nerve pain. Interrupts the inflammatory response at the site of injury or by blocking pain transmission and reception in the brainstem (non- addictive). Lyrica - pregablin Neurotin - gabapentin Tylenol - acetaminophen Ultram - tramadol NSAIDs - the primary action is to block the action of the inflammatory pain mediator Bradykinins.
Non-narcotic analgesics
The weakest level of measurement, categories are very broad
Norminal
Which of the following is NOT an essential component in the implementation of evidence-based practice? -Current research -Clinical experience -Patient goals -Notes from school from 10 years ago
Notes from school from 10 years ago
___________ describes a common course of rehabilitation for tendonitis
PRICEMEM
What is the most common symptom for which an individual seeks medical attention?
Pain
Cardinal signs of inflammation
Pain, Heat, Erythema, Edema, Loss of function
this phase is The long-term goal of wound healing is the return of function. During the final phase of healing, the process of reshaping and reorganizing of the scar tissue occurs (Usually begins Day 9 on.....). Ideally, there should be a balance between the formation of new collagen and the breakdown of old collagen (Mature collagen fibers replace new ones).
Phase 3:Remodeling (Maturation phase, Regeneration phase)
(AKA Inflammation or Substrate Phase): First to occur, lasts approx. 1-10 days (self-defense). Occurs secondary to trauma or disease. Critical to the healing processes - If this phase does not accomplish what it is supposed to, normal healing cannot take place Clot formation and phagocytosis occur (decontamination). Lasts until damaged tissue has been removed & new capillary network has been formed.
Phase I: Acute Inflammatory Phase
When surgical intervention is involved in the closure of a wound, it is termed "healing by first intention." Which of the following reasons would NOT be associated with promoting healing by first intention? Dirt in the wound Infection Excessive drainage Physical condition of the patient
Physical condition of the patient
- is an older term for pain believed to be caused by psychological influences when organic were absent or not severe enough to explain complaint Pain has sensory and psychological components that can complicate its accurate quantification. However there are too many variables that contribute to a patient's painful experience to be able to establish a set percentage.
Psychogenic pain
- includes repeated episodes of acute pain, such as recurrent low back strain, or chronic pain in which the symptoms are intermittent, such as a migraine headache
Recurrent pain
- is pain that arises from deep body structures but is felt at another distant site through the A dermatome is the sensory area of skin supplied by a specific nerve root. is pain that arises from deep body structures but is felt at another distant site through the dermatomes. A dermatome is the area of the skin of the human anatomy that is mainly supplied by branches of a single spinal sensory nerve root. These spinal sensory nerves enter the nerve root at the spinal cord, and their branches reach to the periphery of the body.
Referred pain
Which of the following terms best describes the phenomenon experienced by the patient when painful symptoms are perceived in areas remote from the site of the original tissue damage?
Referred pain
The local application of heat to the low back may also cause which of the following to occur? Reflex heating in other areas of the body, an increase in subcutaneous blood flow, and vasodilation in the distal extremities Reflex cooling of the distal extremities through vasoconstriction Vasoconstriction in the proximal areas to maintain heat
Reflex heating in other areas of the body, an increase in subcutaneous blood flow, and vasodilation in the distal extremities
• Subgroup of elements drawn from a population.
Sample:
Which of the following statements is most accurate? Scar tissue is as strong as the tissue it replaces. Scar tissue is stronger than the tissue it replaces. Scar tissue is not as strong as the tissue it replaces. Scar tissue is 70% as strong as the tissue it replaces
Scar tissue is 70% as strong as the tissue it replaces.
This response Occurs from cell death caused by a blockage of O2 supply. Although inflammation does result in dysfunction, without the inflammation the area would not be able to repair itself.
Secondary Response
• The average deviation of values around the mean. • this is based on the distance of sample values from the mean and equals the square root of the mean. • Expressed differently, the standard deviation is the square root of the variance.
Standard deviation:
- Heat (Capillary permeability to increases due to hangman factor) -Redness (Erythemia is the response to injury) - Swelling (caused by increased capillary hydrostatic pressure, increased interstitial osmotic pressure and an overwhelmed lymphatic system) -Pain - Results in LOSS of Function
The Cardinal Signs of Inflammation:
Uniformity of skin coloration provides information regarding all but which of the following: The amount of melanin present Local circulation Potential sensitivity to thermal agents Skin integrity
The amount of melanin present
The maturity of scar tissue must be taken into consideration when choosing a modality. Which of the following statements is false? Immature scar tissue is well vascularized. The appearance of immature scars will not change when exposed to heat. Mature scars are not as well vascularized as the surrounding tissue.
The appearance of immature scars will not change when exposed to heat.
Prior to an individual being aware of pain, the painful input to the dorsal horn of the spinal cord must travel to the brain. Which of the following scenarios is most accurate in describing the path to the brain? -The axons of most of the transmission cells cross over and ascend via the spinothalamic tract. -The axons of most of the transmission cells ascend ipsilaterally via the spinothalamic tract. -The axons of most of the transmission cells cross over and descend via the lateral spinothalamic tract. -The axons of all of the transmission cells descend over the spinothalamic tract to the brain.
The axons of most of the transmission cells cross over and ascend via the spinothalamic tract.
Which of the following criteria is inconsistent with chronic pain? The cause is well defined. Medical treatments have been ineffective. The painful symptoms have persisted for more than 3 months.
The cause is well defined.
Which of the following best defines the term "control group"?
The group not receiving the intervention
Which of the following best describes the relationship between the numbers of subjects to the strength of the research study?
The higher the number of subjects, the stronger the study.
Elevating the tissue temperature results in an increase in blood flow to the area, attributable in part to the vasodilatory response in surface blood vessels. What mechanism normally prevents excessive heat accumulation? The increased blood flow moves heat into the area, and blood that is relatively warmer from the circulatory system flows into the area. The increased blood flow removes heat from the area, and blood that is relatively warmer from the circulatory system flows into the area. The increased blood flow removes heat from the area, and blood that is relatively cooler from the circulatory system flows into the area.
The increased blood flow removes heat from the area, and blood that is relatively cooler from the circulatory system flows into the area.
The patient is asked to rate his or her pain "on a scale of 0 to10. 0 being no pain and 10 being the worst pain imaginable. This information is then recorded in the patient's chart.
The numeric pain-rating scale (NPRS) is a various of the VAS
Pain has sensory and psychological components that can complicate its accurate quantification. Which of the following percentage relationships most accurately demonstrates the composition of sensory and psychological components of pain? 50% sensory and 50% psychological 80% sensory and 20% psychological 20% sensory and 80% psychological There is no accurate relationship between the sensory and psychological components.
There is no accurate relationship between the sensory and psychological components.
If tear occurs to the vascular area (called zone I red on red) of the meniscus it is reparable (T/F)
True
Because pain that is perceived by the patient appears to arise from the area of referral and not the deeper, more distant structures, it is important to be able to explain to the patient why you may not be treating him "where it hurts" but rather that you are treating the source of the pain (T/F)
True
Experimental pain does not have the psychological components to deal with results that are commonly associated with clinical pain syndromes. (T/F)
True
Phases of the tissue healing can overlap (T/F)
True
Vigorous heating during the proliferation phase may also cause increased bleeding and is contraindicated. (T/F)
True
• The sum of the squared deviation from the mean divided by the total number of values.
Variance
Not as sensitive as the MPQ, this scale is a quick means by which patients can rate pain. The patient is given a piece of paper marked with a line that is 10 cm long. The patient is asked to mark the line at the point corresponding to the intensity of pain felt at that moment. Records can be kept by measuring the position of the marks on the scale from treatment to treatment.
Visual analog Scales
These cells contribute to the localization of burning or pricking pain as well as the discrimination between touch and noxious pinching. - Stimuli produced by motion are carried by mechanoreceptive cells. These cells receive input from both the visceral and the skin. It is thought that this convergence of noxious stimuli may be the basis for referred pain, because the brain may be unable to discriminate between a visceral and a cutaneous source of stimuli. Are also called T (transmission) cells and form the basis for the gate control theory.
Wide-dynamic-range cells:
What is pain?
an unpleasant sensory and emotional experience associated with actual or potential tissue damage
The C and A-delta fibers in the central pathway, When these centrally projecting axons reach the dorsal horn, they branch into___________________ collaterals, forming the dorsolateral Tract of Lissauer.
ascending and descending collaterals
Non-painful sensory stimulus transmitted via A-beta is also thought to ______________
block pain signal transmission in the dorsal horn.
Tendons have the capacity to heal by _________
both intrinsic and extrinsic repair
The ________ of the cells prior to ascending is one of the reasons that sensory stimulation at the spinal cord nerve root on either side can result in pain reduction.
crossing over
Pain occurs concurrently with reaching the tissue limitations Indicates the tissues are in the ________ phase and still healing.
granulation phase
With a deep muscle contusion it is best to avoid ____________to these treatments may promote myositis ossificans
heat, early progressive motion or massage due
Type I (slow twitch) muscle fiber atrophies a great degree with _______
immobilization in a shortened position
Pain before limit in tissue ROM Indicates injury is still in the ________ phase of tissue healing.
inflammatory or early granulation phase
ORIF (Open Reduction Internal fixation) - to __________ a fracture
internally stabilize a fracture
Types of Nociceptors:
mechanical, thermal, polymodal
evidence-based medicine
medicine has been defined as the "integration" of the best clinically relevant research with:
A concentric or eccentric contractions are frequent causes of indirect _________
muscle strains
Pain receptors
nociceptors
Level of measurement that is known as a ranking scale
ordinal
Immobilization and reduced stress decrease ______ and rapid _______ activity
osteoblasts; osteoclast
Memories of past experiences are a component that creates one's _______ These memories come from the Limbic system
pain filter
Experimental pain is pain induced to study ______
physiologic, psychologic, emotional and behavioral responses to stimuli.
Pain occurring after tissue limitation is met Indicates the tissues are likely in the _________ phase and can tolerate more aggressive techniques.
remodeling phase or maturation phase
Ligaments are categorized as a _______
sprain
On a systemic level the ___________ component of the autonomic nervous system (ANS) responds to the perceived threat by a "fight-or-flight" reaction.
sympathetic
Tendons generally receive its blood supply from the _____________
synovium and the musculotendinous junction
In the central pathway, The C and A-delta fibers synapse, either directly or via interneurons, with second-order neurons in the superficial dorsal horn of the gray matter (substantia gelatinosa; Lamina III ). The second-order neurons are
transmission or T-cells
Contrast bath
warm (100-110° F) and cool (55-65° F)
• This study describes the medical history of a single patient in the form of a story and a case series consists of a collection of similar reports. • These are often used to record and alert other health professionals to rare occurrences. • Since there is no control group, case reports and case series are not valid statistically and are therefore considered a source of anecdotal information.
• Case Report or Case Series:
• Subjects are selected as they become available until the desired sample is reached.
• Convenience Sampling:
An untreated subject experiences a change simply from participating in a research study.
• Hawthorne Effect (placebo effect):
• A statement of belief about population parameters
• Hypothesis
Recruitment of volunteers for experimentation MUST involve the subject's complete understanding of the procedures, risks, and demands that may be made.
• Informed Consent
• Numerical measurements describing some characteristic of a population.
• Parameters:
• Group of all elements to be studied
• Population:
• Subjects are deliberately selected based on predefined criteria chosen by the investigator.
• Purposive Sampling:
"Research that derives data from observation, interviews or verbal interactions and focuses on the meanings and interpretations of the participants".
• Qualitative Research:
"Research based on collected objective data that can be subjected to statistical analysis".
• Quantitative Research:
when dealing with narcotic analgesics, call physician if you experience the following:
• SOB (shortness of breath) • Slow HR • Severe dizziness • Severe constipation
• The percentage of individuals with a particular diagnosis that are correctly identified as positive
• Sensitivity:
• Subjects are identified by asking existing subjects to identify the names of other potential participants. • ________ sampling is often used when members of a given sample are difficult to identify.
• Snowball Sampling:
• The percentage of individuals without a particular diagnosis that are correctly identified as negative.
• Specificity:
• Numerical measurement describing some characteristic of a sample.
• Statistic:
Range
• The difference between the highest and lowest value.