OTD 433 PAMS Comprehensive
What did Beecher discover about pain?
discovered there is no relationship between wound severity and intensity of reported pain but there is a relationship between psychological status and objective drug response pain is more complex than originally believed
What is excretion?
elimination of drugs from the body
What is Brunnstrom Stage 1 for the hand?
flaccidity
What is lymph?
fluid collected from interstitial space including lymphocytes, proteins, water, and fat
What action is C5 responsible for?
glenohumeral abduction
What is the role of A-beta fibers?
large pain inhibition fibers
What are the disadvantages of fluidotherapy?
only applicable to distal extremity hands in dependent position treatment can be messy and become a safety issue unit relatively expensive
What is referred pain?
pain at a site other than the actual location of trauma that projects outward from the torso and distally along the extremities
What does the pain pathway look like in the spinal cord? (gate control)
pain signal transmitted by nerve fibers enter the spinal cord at the dorsal horn (gate) and release neurotransmitters to activate nerve cells in spinal cord and process information and transmit it up to the brain
What is chronic pain?
pain that occurs past the point of tissue healing and is less indicative of tissue damage that lasts more than 3-6 months with a non specific identifiable cause due to nerve damage or nervous system reaction the brain and ANS do no think the tissue is healing
What are the three components of gate control theory?
peripheral nerves spinal cord brain
What is the fast pain pathway in the brain?
production of endorphins that travel to the thalamus and cortex to decrease pain or injury by attaching to the Mu receptors (opiod theory)
What is a keloid scar?
scar that goes beyond border of lesion
What is a hypertrophic scar?
scar within the border of lesion
What are hot packs?
silica gell medium covered by a canvas pouch that can reach 158 - 168 degrees
What is modulation TENS?
use of cyclical variation to prevent adaptation of nerves to the current
What does treatment look like for pain vs. stiffness?
Pain: treated daily Stiffness: treated 3-4 days a week
How do you differentiate between nerve root compression and nerve compression?
Spurlings test - positive means there is nerve root compression
What are the pharmacokinetics of glucocorticoids?
absorved well when administered orally bound to plasma protein and distributed through the blood metabolized in the liver and excreted by the kidneys
What is myositis ossificans?
accumulation of mineral deposits in muscle
What is stage III of lymphedema?
accumulation of protein-rich edema fluid that is non-pitting causing fibrosis, sclerosis, and skin changes elephantiasis
What is stage II of lymphedema?
accumulation of protein-rich edema fluid that is pitting and becomes progressively more difficult as connective tissue begins to proliferate causing fibrosis non-reversible
What is stage I of lymphedema?
accumulation of protein-rich edema fluid that is pitting but can be reduced with elevation prevention and early intervention focus
What are some contraindications for k-tape?
active malignancy sites active cellulitis skin infection open wounds DVT
What is iontophoresis?
active transdermal method of delivering ionized drugs topically with direct electrical current non invasive, non-traumatic, and painless as medications are delivered directly to treatment site without complication of parenteral delivery
What is pinocytosis?
active transport in which cell engulfs drug particle transport of fat soluble vitamins
What are some contraindications of complete decongestive therapy?
acute infection cardiac edema malignant disease renal dysfunction acute DVT arterial disease CHF patients over the age of 60 hyper/hypo thyroid recent abdominal surgery Crohn's disease clot-preventing device
What are some precautions for ultrasound?
acute inflammation epiphyseal plates fracture healing breast implants application of cryotherapy primary repair of tendon or ligament
What are some contraindications for superficial heat?
acute musculoskeletal conditions impaired circulation peripheral vascular disease skin anesthesia open wounds or skin conditions increased hydrostatic pressure
What is brief/intense TENS used for?
acute pain - aim to activate small diameter alpha cutaneous afferent over peripheral nerves at site of pain frequency: > 100 pps pulse width: 150-260 milliseconds amplitude: as high intensity that can be tolerated
What is high frequency TENS used for?
acute pain - aims to activily select large diameter beta fibers without stimulating alpha of C fibers or muscle efference frequency: 50-150 pps pulse width: 20-150 milliseconds
What is burst TENS used for?
acute pain - series of pulses repeated 1-5 times/second that allows stimulation of pain carrying fibers while patient perceives comfortable sensationdue to high internal frequency frequency: 50-100 pps pulse width: 20-150 milliseconds
What intensities should be used with each phase of healing?
acute phase 1: 0.1-0.2 subacute phase 2: 0.3-0.7 chronic phase 3: 0.8-2.0
What are some indications for cryotherapy?
acute/subacute inflammation acute pain acute swelling myofascial trigger points muscle guarding muscle spasm acute ligament sprain acute muscle strain acute contusion bursitis tenosynovitis tendinitis delayed onset muscle soreness
What is the significance of a 1:3 on-off ratio?
after each contraction the nerve is able to repolarize with rest reinforces certain movement patterns
How do you manage frozen shoulder?
aggressive joint mobilization and stretching of tight musculature e-stim for pain and US for deep heating
What is systems theory?
all body systems work together to achieve occupational performance and function
What is Brunnstrom Stage 7 for the hand?
all types of prehension with improved skill voluntary finger extension in full ROM and individual finger movement
What are some precautions and contraindications for using tape?
allergies to adhesives or Latex sensitive skin open wounds irritated or red skin rashes
What are the qualities of kinesiotape?
allows for normal ROM restores epidermal tissue homeostasis allows for treatment between taping enhances muscular joint and circulatory function
What is a Y cut?
allows for treatment of 2 different structures for a broader treatment and lower stimulus
What are the advantages of whirlpool bath?
allows observation of body segment permits specialized treatment can control temperature and water agitation suitable for managing soft tissue and improving strength AROM possible durin gimmersion good for wound care
What are some precautions for iontophoresis?
alterations of skin integrity at targeted treatment area can affect drug penetration iontophoresis should not be applied over wounds because damaged skin may affect electrical impedence and increase the risk of discomfort and burns acid and bases forming at electrode may affect delivery of drug physiological effects can occur under electrodes which may influence outcomes use lower level electrical current when using negative electrode
What is lymphatic load?
amount of proteins and fluid
What is pulse rise time?
amount of time needed for pulse to reach peak value rapidly rising pulses causes nerve depolarization
What is pulse decay time?
amount of time required for the pulse to go from peak back to zero
How do you manage a rotator cuff tear?
analgesics, NSAIDs, and electrical stimulation for pain ultrasound for inflammation strengthen rotator cuff to depress and compress humeral head to restore space strengthen lower extremity and trunk to reduce stress of shoulder
What is neovascularization?
angiogenesis macrophage activity signals vascular regeneration to increase blood flow to the area new circulatory loop fills wound making it pink immobilization is essential during the phase to promote vascular regrowth and to prevent new breakdown tissue must regain homeostasis
What are corticosteroids?
anti-inflammatory agents that slow initial movement of neutrophils and monocytes to an inflammation site and inhibits rate of activity at site used to treat acute inflammatory, musculoskeletal conditions, and well-localized point specific injuries don't use following surgery since they slow down healing
What is cryoimmersion?
application of cold water using body segment immersion technique
What factors should be considered with ultrasound?
area treated - volume, depth, and acuity frequency duty cycle duration intensity therapeutic goal - stage of healing, pain, mechanism of injury
What are some regional factors that can affect healing?
arterial insufficiency neuropathy venous insufficiency
What is the pulse strength duration curve?
as amplitude increases, different peripheral nerves are recruited sensory nerves - motor nerves - nociceptors - opiod pathway goes superficial to deep
What does intervention look like during the inflammatory phase?
assist the macrophages and prevent prolonged inflammation antibiotics, debridement, wound cleaning, PRICE (position, rest, ice, compression, elevation)
What are the features of the ionto units?
automatically ramp up and down automatically shut off monitor skin resistance display treatment status allow treatment pauses provide audible and visual alerts activate other safety measures through pre-programmed current and time limits direct current power source, drugs, and electrodes must be used according to the manufacturer's technical guidelines to ensure safety, effectiveness, and reproducibility
What is self-mobilization?
automobilization self stretching technique that specifically uses joint traction or glides that direct the stretch force to the joint capsule
What are the application procedures for fluidotherapy?
bandage and cover and secure any open wounds, immobilize sleeve set temperature gauge adjust degree of air flow and agitation
What are the physiological effects of k-tape?
based off of tension theory in which the application of tape facilitates the differentiation of collagen fibers by applying low-load long duration strength with teh controlled force of the stretch in the tape skin: scar management fascia: fascitis compartment syndrome, ITB, lateral epicondylitis joints: functional and mechanical correction circulatory/lymphatics: edema, hematoma/bruising muscle: inhibition and facilitation
What is Brunnstrom Stage 3 of the upper extremity?
beginning voluntary movement but only in synergy increased spasticity which may become severe
What is granulation scar tissue?
body glue that is red in color and matures into desnse fibrous scar
What is metabolism of drugs?
body's ability to change a drug from its dosage form to a more water-soluble form that can be excreted metabolized into metabolites that can be active and exert pharmacologic actions or inactive metabolites are excreted metabolized at the liver
What is an inflammatory response?
body's direct response to tissue damage that causes acute pain alerts the brain, attempts homeostasis, releases cortisol, and suppresses the immune system
Your patient describes their pain as deep, nagging, and dull. What kind of pain is this?
bone pain
What are the goals of soft tissue mobilization?
break down or reduce adhesions improve ROM lengthen muscles and tendons reduce swelling and edema decrease pain restore functionality stimulate rehabilitation and recovery
What is instrument assist soft tissue mobilization?
breaks soft tissue dysfunction or musculoskeletal disorders by covering larger areas and saving energy and wear of the therapist
What is a muscle contusion?
bruises characterized by ecchymosis/discoloration, swelling, hematoma, or the formation of a hard feeling mass
What is cavitation?
bubbles form in the fluid from the kinetic energy waves that alters teh cell membrane potential limited by low intensity, high frequency, and pulsed ultrasound
What is fibrosis/scar tissue?
bulky mass of fibrous scar tissue completely surrounds region
What are some contraindications for TENS?
cardiac pacemaker labor and delivery trunk and abdomen of pregnant women over the eyes peripheral vascular disease or infection decreased or absent sensation undiagnosed pain carotid sinus areas trans-cerebrally acute pain as a protective mechanism
What clinical conditions can be treated with iontophoresis?
carpal tunnel syndrome epicondylitis ulnar nerve inflammation elbow strain/sprain radiohumeral bursitis triceps tendonitis gleno-humeral bursitis reflex sympathetic dystrophy hand and wrist tendinitis/tenosynovitis De Quervain's disease acute inflammation or injury
What is the inflammatory pain response?
cascade of hyper-excitable events occur in nervous system following trauma that start at the skin and potentiate along peripheral nerves to create a hypersensitive response in the spinal cord and brain inflammatory cells surround area and produce cytokines and chemokines to mediate healing and tissue regeneration but also can be irritant and change the properties of the primary sensory neurons surrounding the area
What are the application procedures for whirlpool bath?
check water temperature 100-104 for heating 90-100 for open wounds position patient and submerge extremity in tank start agitation and adjust speed and direction of water flow stay with patient entire treatment session
What is the slow pain pathway in the brain?
chronic afferent pathway to hypothalamus and limbic system that releases stress hormone and pain i s assigned meaning
What is motor level stimulation for TENS?
chronic pain - isometric or isotonic contraction created by using higher amplitude due to the recruitment of additional motor axons or muscle fibers activates gate control and opiate theory to treat chronic pain Pulse duration: 150-200 milliseconds Frequency: 2-10 PPS Amplitude: reached with muscle twitch/fasiculations
What is low frequency TENS used for?
chronic pain - selectively activates small diameter nerve fibers arising from muscles to induce a phasic muscle twitch Frequency: 1-4 pps Pulse Width - 150-250 milliseconds
What is the top/down definition of function?
client's performance of life roles and meaningful activities that are part of those roles assessment focused on client's participation restriction, occupational balance, and life role configuration uses occupation as means and an end
What is epithelialization?
close off the wound to create a protective barrier to prevent loss of fluid from the wound and decrease infection migration from periphery causing a "pull" on normal skin around wound barrier
What is collagen orientation?
collagen will be rearranged in linear or lateral orientation and will match the tissue that surrounds it to help provide a specific function ex. tendon, muscle, skin, etc.
What is a cryopressure unit?
combined pressure sleeve with cooling effect
What is Klatenborn Traction Grading Scale?
combines tractiona nd mobilization to determine joint slack
What is wound healing?
complex and dynamic process as the body attempts to close the wound and restore functions of the damaged tissue
What are client factors?
components which reside within or are unique biophysiological factors of the individual affects ability to engage in occupation and activities AOTA's definition: component that includes body function and body structures
What compromises the shoulder? What is it's function?
composed of 3 synovial joints and one pseudojoint that maximizes mobility at the sake of stability primary purpose is to position hand for function
What is dosage for iontophoresis?
concentration number of ions transported to the tissue measured in milliamp-minutes (mA/min)
What is mobilization with movement (MWM)?
concurrent application of a sustained accessory mobilization applied by a clinician and an active physiologic movement to end range applied by the patient applied in a pain free direction
How do superficial thermal agents work?
conduction: direct contact with tissue convection: energy swirls around tissue
What is the lymphatic system? How does it work?
consists of lymph vessels and organs that produce lymphocytes to recognize foreign cells, substances, microbes, and cancer cells to destroy and eliminate them from the body organs: lymph nodes, lymph vessels, thymus gland, spleen, tonsils, and Peyer's patches absorbs, transports, and recycles protein from interstitial space through microcirculation process of diffusion, osmosis, and pressure gradient on interstitial tissue
What is a direct current?
constant direction of electric current with uninterrupted flow of charged particles acidic reaction occurs at the anode (oxidation) and alkaline reaction at the cathode
What is sensory level stimulation for TENS?
conventional TENS used for acute stages of an injury that activates cutaneous tactile sensory fibers to get a sensory response without motor contraction pulse duration: 50-100 milliseconds frequency: 80-100 PPS amplitude: tingling, tapping, pins and needles decreases nociceptive response within 5 minutes and prolonged reduction due to pain-spasm pain cycle
What is cryocompression?
cooling, pressurized sleeve over the extremity
What are the effects of taping?
corrects biomechanical abnormalities related to pain decreases pain proprioceptive feedback soft-tissue unloading/neural tissue unloading braces, supports, and stabilizes the joint assists in retraining muscles
What is a muscle injury?
cramp - painful clonic type muscle pain muscle spasm - involuntary contraction for a short duration inflammation
What is superficial cooling?
cryotherapy produces lower tissue temperature resulting in analgesia and are recommended for acute condition
What variables impact dosage for iontophoresis?
current amplitude duration of current flow volume of medication will not affect the amount of ions delivered when they have the same concentration
What is a pulsatile current?
current flows in unidirectional or bidirectional movement and is periodically interrupted to produce a specific biophysical effect
What is convex?
curved or rounded outward
What is peripheral sensitization?
damage to high threshold nociceptors that amplifies the excitability of neurons within the CNS causing hypersensitivity that can lead to central sensitization associated with acute pain
What is central sensitization?
damage to the nociceptors that modifies and modulates neurons in nervous system and amplifies the excitability of neurons within the CNS repeated stimulation creates brain memory for specific pain response and brain responds more rapidly and effectively and changes the brain wiring and brain becomes more excitable and hypersensitive to pain pathway
What is the resolution phase?
dead cellular material and debris is removed by phagocytosis and tissue is left with its original architecture in tact make space for new tissue
What is compression in joint mobilization?
decrease in space between 2 joint surfaces to add stability to a joint normal reaction of a joint to muscle contraction
What are the physiologic effects of cryotherapy?
decrease temperature of injured area decreases metabolic rate decreases pain promotes local vasoconstriction contributes to control of edema and hemorrhage
What are the diagnostic indicators for k-tape?
decreased muscle strength increased tone and overactive muscle inhibition swelling pain scar tissue asymmetrical posture/movement sensory stimulation hypermobility tape provides feedback to motor response multiple layers are needed for spasticity and muscle tone
How does superficial heat effect pain?
decreases due to counter-irritation and alters nerve conduction velocities and transmission
How does cryotherapy effect pain?
decreases due to counter-irritation that decreases chemical mediators and metabolites decreased sensory nerve conduction velocities and activity of A-delta fibers
How does superficial heat effect muscle spasms?
decreases due to gamma efferent activity, decrease spindle sensitivity to stretch and decreases in strength
How does cryotherapy effect blood flow?
decreases due to reflex vasoconstriction, increased blood viscosity and decreased mobility of non-elastic tissues
How does cryotherapy effect inflammation and edema?
decreases due to vasoconstriction and increased blood viscosity causing less fluid infiltration into interstitial spaces that decreases metabolic and vasoactive agents leading to less inflammatory cascade
How does cryotherapy effect connective tissue extensibility and stiffness?
decreases extensibility and increases stiffness due to increased tissue viscosity and decreased mobility of non-elastic tissues
How does cryotherapy effect muscle spasms?
decreases spindle afferent discharges when cooled directly when cooled indirectly, reflex decreases in gamma motor neuron activity via stimulation of cutaneous afferent
How is ultrasound classified?
deep hear or superficial thermal modality with thermal and mechanical effects that uses acoustic and kinetic energy to promote soft tissue repair and pain relief Heat soft tissue Heal by enhancing inflammatory response and tissue repair
What is the minimum time needed for iontophoresis at max current density?
delivery at maximum current of 4 mA will take 9.8 minutes for treatment duration
What are the large movers of the GH joint?
deltoid latissimus dorsi teres major pectoralis major coracobrachialis
What are nociceptors?
detect sensation as other receptors with a higher activation threshold to detect potential or actual tissue damage
What is a second degree strain/sprain?
detectable joint instability and muscle weakness
What are some precautions for k-tape?
diabetes fracture kidney/liver disease (fluid removal) congestive heart failure carotid artery fragile or healing skin tape allergy lymphedema respiratory condition pregnancies allergies (bananas, kiwi, strawberry, pineapple, passion fruit, chestnuts, soy, and avocado)
What are the variables for a nerve response?
diameter of the nerve depth of the nerve in relation to the electrode duration of the pulse TENS stimulates superficial sensory nerve first to override pain receptors by masking the pain
What is a differential diagnosis?
differentiate one or more conditions for accuracy and specificity of diagnosis looks at the signs and symptoms
What are the physiologic effects of superficial heating?
dilated blood vessels causing capillaries to open up and increase circulation to increase metabolic rate, production of metabolites, intravascular pressure, arteriole vasodilation and increased blood flow
What is conduction?
direct contact with agent that is dependent on temperature and duration
How do ions move during iontophoresis?
direct current moves ions in a particupar direction based on the principle that like charges repel each other allowing the elctrode to push the drug of the same charge into the system ions cross the stratum corneum, penetrate subcutaneous tissue and superficial muscles, then enters the systemic circulation
What is an alternating current?
direction of charge alternates between positive and negative
What is amplitude?
distance of rise above or below baseline of each pulse strength of electrical current and is maximum deviation that occurs for each phase y-axis
What are the nutritional effects of joint mobilization?
distraction or small gliding movement cause synovial fluid movement that improves nutrient exchange due to joint swelling and immobilization
What are iatrogenic effects?
drug effects that mimica pathoogic disorders
What are pharmacokinetics?
drug's action as it moves through the body absorption, distribution, metabolism, and excretion also concerned with drug's onset of action, peak concentration level, and duration of action
What are some medication considerations for iontophoresis?
drugs must be water-soluble and ionized follow as US Pharmacopoeia standards to maintain potency and stability until expiration date
What are some intervention approaches that follow tension theory?
dynamic splint serial casting positional heat and stretching technique functional electrical stimulation selective hand activities
What are the advantages of paraffin bath?
easy to apply efficient relatively inexpensive heat distributed evenly dosage levels can be adjusted mineral oil lubricates the skin passive stretch to finger joints can be sustained using Coban tape moderate dose effective for patients with rheumatoid arthritis
What are the advantages of fluidotherapy?
easy to operate and move does not require towels or plumbing fixture heat evenly distributed over entire area adjustment to air flow allows effective intervention to treat hypertension PROM, AAROM, AROM are possible during application
What is a web cut?
effective for larger areas for edema resolution
What are some indications for iontophoresis?
effective intervention used to treat musculoskeletal inflammatory conditions, decreased joint pain and inflammation, and as a local anesthetic
What is the duration for ultrasound?
effective radiating dose is 2 times the diameter of the sound head and takes 1 min to cover treatment head over tissue larger the area the greater time required 5-10 minute window for stretching
What is ovoid?
egg one surface is convex and the other surface is concave
What actions is C6 responsible for?
elbow flexion elbow extension wrist flexion
What is the significance of a parallel circuit?
electric current will follow path of least resistance even if it has to travel a longer distance body composed of different tissues that conduct electricity differently
What is radiation?
energy is transferred through space to the extremity
What is convection?
energy moves around the extremity
What are electrodes?
ensures conductivity between electrodes and skin to allow current to flow from stimulation device into the body
What is acute recurrent pain?
episodes of pain with pain free periods between "flare ups" that lasts less than 3 months with an identified physical process
How does superficial heat effect connective tissue extensibility and stiffness?
extensibility increases and stiffness decreases due to changes in viscoelastic properties of tissue and mobility of periarticular structures
How do you manage chronic recurrent instability?
extensive strengthening of rotator cuff and scapular stabilizing muscles avoid joint mobilization and flexibility exercises
What are the disadvantages of whirlpool bath?
extremity held in dependent position risk of cross contamination time consuming and messy requires large amount of hot water
What does the treatment rotation look like for contrast bath?
extremity held in hot water for 3-4 minutes (105-110 degrees) followed by immersing extremity for one minute in cold water (50-60 degrees) end treatment will depend on rationale for treatment and overall treatment objectives
What are synergy patterns?
failure of the antagonsit to relax when the agonsit contracts which leads to co-contraction
What action is T1 responsible for?
finger abduction and adduction
What is Brunnstrom Stage 1 of the upper extremity?
flaccidity no voluntary movement or stretch reflexes
What is electrical current?
flow/movement of ions (electrons) through the path of least resistance to go from high concentration (-cathode) to low concentration (+anode)
What is ultrafiltration?
fluid leavin gthe arterial side of capillaries
What are some common deficits seen with k-tape?
following injury, CVA, or TBI changes in muscle tone, muscle strength, pain, swelling, postural changes, secondary injuries secondary injuries: hematoma, ligament injury, pain, swelling, orthopedic injury, musculoskeletal injury
What is mechanical resistance exercise?
form of active resistance exercise in which resistance is applied through use of equipment or mechanical apparatus that is useful when amount of resistance necessary is greater than what the therapist can apply manually
What is ASTYM?
form of instrument assist soft tissue mobilization that addresses the entire kinetic chain and reestablishes normal movement patterns and guides healing for optimal outcomes restores tissue to pre-injury levels with macrophage mediated phagocytosis, remodeling and regeneration of degenerated and dysfunctional tissue and restoration of normal movement pattern
What is the scapulothoracic joint function?
formed by subscapular bursa and serratus anterior maintains length-tension relationship of rotator cuff and deltoid position glenoid to receive humeral head absorbs shock permits elevation of body (scapular depression) enhances shoulder ROM
What are some precautions for NMES?
fracture decreased sensation decreased cognitive ability comatose condition pregnancy allergy or skin sensitivity
Your patient describes their pain as sharp, severe, and intolerable. What kind of pain is this?
fracture pain
What is an ice cup?
frozen water in styrofoam/paper cup
What is an icicle?
frozen water on wooden stick
What are the advantages of a hot pack?
generally easy to use requires minimal maintenance provides moderate and vigorous doses of heat various sizes and shapes passive form of treatment body segment can be placed into sustained positional stretch
What is the significance of a 1:5 on-off ratio?
gives the muscle more time to rest and avoids fatigue helps to overcome neurologic patterns or can be used when patient can't actively move self
What is the Maitland Joint Mobilization Grading Scale
grading based on amplitude of movement and where within available ROM the force is applied pain is treated before stiffness grades 1 and 2 are often used before and after treatment with grade 3 and 4
What are the non-thermal/mechanical effects of ultrasound?
healing minimized/eliminated thermal effects by using a low-intensity and pulse mode delivery that facilitates healing
How does TENS decrease pain?
high pulse frequency, short duration, sensory level current activates the gate control theory of pain by disrupting the pain ->(TENS) spasm -> ischemia -> dysfunction cycle
What is thrust?
high velocity, short amplitude motion that the patient can not prevent performed at end of pathologic limit of joint not in the scope of OT
What is concave?
hollowed or rounded inward
What is the duty cycle for ultrasound?
how often energy is pulsed through the sound head 20%, 50%, or 100%
What is a whirlpool bath?
hydrotherapy process that uses forced air to agitate water ina tank to provide mild, moderate, or vigorous doses of heat water buoyancy can enhance exercise and can aid recently healed fractures, inflammatory condition, peripheral vascular disease, and peripheral nerve injuries
What are some precautions for complete decongestive therapy
hypertension paralysis diabetes asthma CHF
How would you tape for muscle tone changes?
hypertonicity tape for inhibition to increase passive range of motion, decrease pain, and allow for increased active range of motion
What was specificity theory?
idea that pain is a direct transmission system of a pain impulse from nociceptor carried by A-delta and C-fibers from periphery to pain center in the brain via the lateral spinothalamic tract mental pain is different from physical pain
What are the benefits of ASTYM?
identify dysfunctional tissue provide body with a stimulus to jump start healing deliver stimulus with less stress on clinician assess and stimulate the entire kinetic chain efficiently
What effects on healing does the inflammatory phase have?
if too little inflammation occurs, the healing response is slow if too much inflammation occurs, excessive scar is produced
What are contrast baths?
immersing an extremity in alternating tubs of hot and cold water to promote blood flow and help with venous and lymphatic return
What are some contraindications of cryotherapy?
impaired circulation peripheral vascular disease hypersensitivity to cold skin anesthesia open wounds or skin conditions infection
What are the indicators for NMES?
improve muscle strength without increasing cardiovascular output enhance ROM inhibit spasticity or muscle spasms improve endurance muscle re-education neuro-muscular facilitation inhibit orthotic substitution control edema in acute and chronic condition
What are the mechanical effects of joint mobilization?
improves mobility of hypomobile joint and maintains extensibility and tensile strength of articular tissue
What does amplitude look like for strengthening?
increase amplitude to about half of the maximum isometric muscle contraction will result in a muscle grade of 3
What are some examples of faster route absorption?
increased blood flow inhalation
What is the physioogy behind soft tissue mobilization?
increased fibroblast proliferation reduction in scar increased vascular response remodeling of unorganized collagen fiber matrix
How does superficial heat effect inflammation and edema?
increases due to reflex vasodilation causing mild inflammatory response that increase metabolism and O2 uptake
How does superficial heat effect blood flow?
increases due to vasodilation and increases arteriole and capillary permeability
What is Brunnstrom Stage 5 of the upper extremity?
independence from basic synergies arm to side horizontal postiion arm forward overhead pronation and supination with arm fully extended spasticity waning
What is pulse train?
individual pattern of waveform, duration, and/or frequencies that are linked together repeated at regular intervals
What are some contraindications for soft tissue mobilization?
infections open wounds diabetic ulcers abdomen of pregnant women compromised skin integrity around pacemaker or internal defibrillator anterior triangle of neck-carotid sinus acute deep vein thrombosis
What is tendonitis?
inflammation of a tendon or tendon sheath (tenosynovitis) acute or chronic pain and swelling with tendon movement
What are the contraindications of joint mobilization?
inflammatory arthritis malignancy tuberculosis osteopororsis ligamentous rupture herniated disk with nerve compression bone disease neurological involvement bone fracture congenital bone deformities vascular disorder joint effusion
What is the mechanism of action behind k-tape?
injury causes compression of space between the epidermis and muscle which compresses the nerve receptors causing them to send information to the brain regarding continuous touch and pressure which causes the brain to send signals to the body to react ot the stimuli K-tape alters the information that these receptors send to the brain and causes a less reactive response in the body allowing the body to work in more normal manner and removing some roadblocks that slow down the healing process
What is the bioelectric system and how can electrotherapeutic interventions be used?
injury disrupts body's natural electric fields current at injured site influences histochemical substrates associated with healing process and adjacent epidermis becomes positively charged relative to the uninjured tissue bioelectric system attracts cells that facilitate cellular secretion, orient cell structues, and repair tissue
What are some adverse reactions to glucocorticoids?
insomnia suppressed immune or inflammatory responses osteoperosis impaired wound healing
What is evidence based practice?
integration of clinical expertise, patient values, and best research evidence into the decision making process for patient care
What are the thermal effects of ultrasound?
intensity is high enough to cause heating of tissue with the same biophysiological effects of superficial thermal agent that occurs deeper
What is the beam nonuniformity ratio (BMR)?
irregular ratio of energy coming off the sound head average amount of sound energy by moving sound head
What is bursitis?
irritation of bursa
What is Brunnstrom Stage 6 of the upper extremity?
isolate joint movements that are freely performed with near normal coordination and minimal spasticity
What are the treatment principles for joint mobilization?
know the shape of the joint place patient in a maximally relaxed position start articulation in resting position of joint use good body mechanics work with gravity stabilize one bone and support the area articulate with other hand keeping both hands as close as possible to joint surfaces never move into painful ROM never articulate joint in close packed position direction of movement during treatment is either parallel or perpendicular to the treatment plane (concave perpendicular to the convex)
What are the supporting structures of the GH joint?
labrum joint capsule GH ligaments (3) coracohumeral ligament muscles: supraspinatus, infraspinatus, teres minor, subscapularis, biceps and triceps brachii
How does electrically stimulated movement work?
large fibers and muscles are recruited in a synchronous pattern (all or none) muscles fatigue rapidly and limits finely controlled quality of functional movement
Why is the epidermis significant for iontophoresis?
layer of skin made up of corneocytes that are separated by free fatty acids that form a lipid environment as a barrier to water and other ionic substances as a protective function drugs that penetrate the stratum corneum can passively diffuse into underlying subcutaneous tissue
What is pulse duration?
length of time required to complete shape x axis
What is duration of action?
length of time the drug produces its therapeutic effect and is measured in half life
What is Brunnstrom Stage 2 for the hand?
little or no active finger flexion
How do you test for glenohumeral instability?
load and shift test sulcus sign apprehension test anterior and posterior drawer test clunk test
What is Klatenborn grade I?
loosen neutralizes pressure in joint without actual surface separation to produce pain relief by reducing compressive forces
What is the repair phase?
lost tissue is replaced by a fibrous scar
What is the regeneration phase?
lost tissue is replaced by proliferation of cells of same type which reconstruct the normal structure creation of new tissue
What are some barriers to healing?
low blood oxygen content infection lack of perfusion sustained pressure malnutrition systemic diseases immunosuppressants smoking
What are the contraindications for NMES?
lower back or uterus during first trimester metastases osteomyelitis allergy to iontophoretically delivered medication diuretic medication phrenic nerve or bladder stimulators carotid sinuses diathery devices superficial metal hardware cancer cardiac pacemaker
What is the intensity of ultrasound?
magnitude of force in a sound wave as intensity increases so does the excursion of molecules most significant factor for tissue response
What is categorized under orthopedic, neurological in the new medicare payment system?
major joint replacement or spinal surgery non-orthopedice surgery acute neurologic non-surgical orthopedic/musculoskeletal medical management
How do you test for sternoclavicular instability?
manipulation of clavicle for excess motion
What is included in complete decongestive therapy?
manual lymph drainage massage compression client education meticulous sin care exercise
How do you treat scar adhesions?
manual scar mobilization used to soften scar tissue to provide desensitization, prevent adhesions to tissue, and improve lymph circulation myofascial release ROM and manual stretching
What is joint mobilization?
manual therapy technique used to modulate pain, increase ROM, and treat joint dysfunction that limits ROM by specifically addressing altered joint mechanics
What is the drug therapeutic index?
margin of safety relationship between a drug's desired therapeutic effects and its adverse effects
What is Brunnstrom Stage 3 for the hand?
mass grasp or hook grasp in flexor pattern only no voluntary finger extension or release
What is isokinetic exercise?
maximum effort of patient during each repetition of exercise so the contracting muscle produces variable but maximum force output
What is shoulder impingement syndrome?
mechanical compression of supraspinatus tendon, subacromial bursa, and long head of the biceps tendon due to decreased space under the coracoacromial arch exacerbating factors include laxity and inflammation and postural malalignment
What are some local factors that can affect healing?
mechanical injury type of injury infection edema ischemia necrotic tissue topical agents ionizing radiation low oxygen foreign bodies
What is categorized under medical complexity in the new medicare payment system?
medical management pulmonary cardiovascular and coagulation cancer acute infection
What is the efferent pathway? (gate control)
messages descend from brain to spinal cord that opens or closes the gate
What are the disadvantages of paraffin bath?
messy expensive to replace wax mixture danger of contamination cleaning tank can be difficult vigorous doses can increase harmful enzymatic activity for patients with rheumatoid arthritis
What is the sub sensory level of stimulation for TENS?
microcurrent electrical stimulation (MENS) or subliminal stimulation with current intensity below the threshold for nerve depolarization used to enhance cellular physiology and processes
If your goal is muscle re-education, what should you do?
mild tonic contraction used to cue the patient of desired movement and contraction
What is manual lymph drainage?
mild, superficial massage aimed to manually move lymph out of limb or body part improves lymph production, increases lymphangio motoricity, improves lymph circulation, special stroke to help break down fibrotic tissue, promotes relaxation and has analgesic effects
What is calcific tendinitis?
mineral deposits in tendon
What is a chemical pack?
mixture of 2 chemicals together to attain effect
What is an ice pack?
mixture of crushed ice and cold water in plastic bag covered with a towel
What is a gel pack?
mixture of water and antifreeze in vinyl cover
What is the concave-convex rule?
mobile concave joint surfaces slide in the same direction as bone movement on stable convex joint glide occurs in the same direction as the roll
What is the convex-concave rule?
mobile convex joint surfaces slide in the opposite direction as bone movement of stable concave surface gliding occurs in the opposite direction of the roll
What is the application method for paraffin bath?
moderate dose: dip hand 10 times, wrap in plastic bag drape with clot towel or brush 10 coats onto body segment and cover with plastic and drape towel vigorous dose: dip hand 7 times and submerge in paraffin bath for 20 minutes
What is sound propagation?
molecules are originally parallel to each other and the flow and rapid generation of sound waves push the molecules back and forth to convert sound energy into kinetic energy longitudinal and compressional waves
What are some contraindications for ultrasound?
mostly applies to thermal effects over organs pelvis, abdomen, and lumbar region in pregnant women over highly ultrasound-sensitive organs DVT areas with poor circulation surgical laminectomies of spine tissue/bone with infection pace maker or electronic implants cancerous areas desensitized areas of the skin front of upper neck joint and tissue injected with medication plastic/cement implants bony prominences growth plates precondition with heat or cold
What are arthrokinematics?
motion of bone surface within the joint roll, spin, slide, compression, distraction
What is joint play?
motion that occurs within the joint determined by joint capsule's laxity can be demonstrated passively, but not performed actively
A phase duration of 200-400 usec will recruit what peripheral nerves?
motor nerves through A-alpha fibers that are necessary for muscle contraction
How do you treat the shoulder in the spastic stage?
movement is often severely limited and to relieve spasticity and maintain range you must have expert handling! no pulley or steroid injections
What are physiologic movements?
movements done voluntarily including arthrokinematics and osteokinematics results of concentric or eccentric active muscle contraction as bones move about an axis (flexion, extension, abduction, adduction, and rotation)
What are accessory movements?
movements within the joint and surrounding tissues that are necessary for normal ROM but cannot be voluntarily performed motion of articular surfaces relative to one another that involve ligament and joint capsule and are necessary for full range of physiologic motion component motions: motions that accompany active motion but are not under voluntary control
Your patient describes their pain is cramping, dull, and aching. What kind of pain is this?
muscle pain
What happens if cortisol continues to be released during an inflammatory response?
myopathy, weakness, fatigue, decalcification, GI problems, aches and pain, anxiety, belly fat, sugar cravings
What are some interfering factors with epithelialization?
necrotic tissue large wounds poor oxygen supply insufficient capillary circulation
What is gabapentin?
negative polarity (neurontin) decreases calcium influx and inhibits excitatory neurotransmitters to help relieve neuropathy and neuropathic pain
What is dexamethasone?
negative polarity glucocortocoid medication used to treat acute and chronic inflammation conditions traditional drug of choice for iontophoresis
What is ketoprofen 10%?
negative polarity nonsteroidal anti inflammatory medication (NSAID) used to treat inflammation and pain of acute and chronic musculoskeletal conditions
What is potassium iodide?
negative polarity sclerolytic used to decrease scar tissue and release tendon adhesions
What is acetic acid 4%?
negative polarity used for acute or chronic soft-tissue calcific mineralization, heel spurs, calcific tendinits, and myositis ossificans
Your patient describes their pain as sharp, bright, lightning like. What kind of pain is this?
nerve pain
What is neuropathic pain?
nerve pain due to injury or irritation to sensory or motor nerves that persist unrelated to injury or condition
What is neuropathic pain?
nerve pain/neuropathy causing injury or irritation to nerve and pain persists unrelated to injury or condition under chronic pain category
Your patient describes their pain is sharp and shooting. What kind of pain is this?
nerve root pain
Your patient describes their pain as sever, sharp, stabbing, ongoing, numbness, tingling, and complains of weakness. What do you think it is?
neuropathic pain CRPS/RSD, post herpetic neuralgia, radiculopathy
What is a first degree strain/sprain?
no readily observable tissue destruction
How does nociception work in the peripheral nerves?
nociceptors convert external traumatic stimuli into electrical activity as primary afferent nerves that conduct sensory information from PNS to CNS CNS pain information is transmitted from primary sensory neuron to central projection neurons
What is the frequency of ultrasound?
number of complete wave cycles generated each second influences the amount of energy absorved 1.0MHz (1-5cm) or 3.0MHz (1-2cm)
What is pulse charge?
number of electrons contained within a pulse
What is pulse frequency?
number of events per second pps
What are some factors that impact the effectiveness of iontophoresis?
number of ions being transferred depth of penetration how the ions combine chemically with other substances of the skin the ability of ions to enter the body skin integrity at treatment site polarity of treatment electrode and drug ion pH and concentration of drug solution competing ions in solution application of treatment electrical stimulation parameters note: high concentration medications are not more effective
What is collagen production?
occurs at peak of wound healing in which fibroblasts produce a tropocollagen molecule to form scar over wound quantity of scar production is an indication of final outcome mobilization can break scar and create a new wound
What is a shear wave?
occurs in solid medium that plays a role in bone healing without heating the soft tissue
What is a spin in joint mobilization?
occurs when one bone rotates around a stationary longitudinal mechanical axis same point on the moving surface creates an arc of a circle as the bone spins
What is the significance of a 1:1 on-off ratio?
on time is the same as off time that creates a power ratio when client has active voluntary movement and can move on to volitional movement
What are some examples of slow rate absorption?
oral intermuscular subcutaneous routes high fat meals and solid food
What are the precautions for joint mobilization?
osteoarthritis pregnancy flu total joint replacement severe scoliosis poor general health inability of patient to relax
If your goal is to increase muscle strength, what should you do?
outpout of treatment should be as high as the patient can tolerate
What are the factors that can limit joint mechanics?
pain and muscle guarding joint hypomobility that decreases ROM joint effusion contracture or adhesions in joint capsule or supporting ligaments biomechanical abnormalitites (misalignment or subluxation)
A phase duration of 400-1000 usec will recruit what peripheral nerves?
pain carrying nerve fibers
What does the pain pathway look like in the brain? (gate control)
pain messages travel up the spinal cord and arrive at the thalamus that forwards messages to the somatosensory cortex, limbic system, and the frontal cortex brain responds to messages by sending a secondary message to spinal cord to moderate pain (gate control)
What is Transcutaneous electrical nerve stimulation (TENS)?
pain modulation that affects the perceptual component of pain through low voltage electrical pulses to the low threshold sensory nerves target gate theory and endorphin/opiate mediated control theory by stimulating large Beta fibers
What is referred pain?
pain perceived at a location other than the site of painful stimuli/origin due to network of interconnecting sensory nerves and different tissue
What is gate control theory? (Melzack and Wall)
pain results from a series of exchanges among the peripheral nerves, spinal cord, and the brain
What is radiating pain?
pain that originates from an irritated nerve root and travels along the nerve's dermatome
What is Brunnstrom Stage 5 for the hand?
palmar prehension with an awkward cylindrical or spherical grasp
What is the Modified Neer's Test? What does it indicate?
participant is seated and forced passive forward flexion, hand-behind-neck and passive external rotation and abduction compare both sides positive results and 10 degrees difference between extremities indicates higher likelihood of experiencing shoulder pain later
What is mobilization?
passive joint movement for increasing ROM or decreasing pain that is applied to joints and related soft tissues at varying speeds and amplitudes using physiologic or accessory motion force is light enough that patient can stop the movement
What is manipulation?
passive joint movement for increasing joint mobility that incorporates a sudden, forceful thrust that is beyond the patient's control
What is a wound?
pathological state in which tissues are separated from each other and/or destroyed
What are drug allergies?
patient's immune system identifies a drug as a dangerous, foreign substance to be neutralized or destroyed
What is the focus of OT and oncology?
patient/family education address psychosocial issues, self-esteem, and wellness energy conservation and activity modification tissue mobilization and scar management stress management, relaxation home exercise programs adaptive equipment discharge recommendations for safety assess cognitive changes lymphedema management hospice and palliative care options
What are superficial thermal agents?
penetrat 1-2cm with heating or cooling energy ex: hydrotherapy, whirlpool, cryotherapy, fluidotherapy, hot pack, paraffin, water, infrared
What are deep thermal agents?
penetrate 0-5cm with heating or cooling energy ex. therapeutic ultrasound, phonophoresis, diathermy
What are signs for differential diagnosis?
phenomenon which are directly tested and perceived by a clinician objective measures
What is tension theory?
physical changes in scar length can be achieved through a low-load, long duration application of stress during appropriate healing phase
How do you test for acromioclavicular instability?
piano key sign horizontal adduction test AC compression/Sheer test joint distraction test
What are the biophysical principles for ultrasound?
piezoelectric effect - crystal oscillation when crystal vibrates and resonates to produce sound and pressure waves that are transmitted to small volume of tissue causing the molecules to vibrate
Why is protein binding important for drug distribution and iontophoresis?
portion of drug that is bound is inactive and only the free, unbound portion of the drug remains active iontophoresis is more effective than this
What is important about the electrode placement for TENS?
position electrodes over or around painful site using motor point, trigger point, and acupuncture point place electrode parallel to, on either side of, or crossed to the site
What is resting position?
position where surrounding tissue is as relaxed as possible and intracapsular space is as large as possible articulation should always start here
What is closed pack position?
position where surrounding tissue is as tight as possible and intracapsular space is as small as possible never articulate in this position
What is magnesium sulfate?
positive polarity helps relieve acute muscle spasm, neuralgia, and stiffness by decreasing excitability or skeletal muscle and slows nerve transmission
What is lidocaine?
positive polarity local anesthetic that produces numbness and temporary pain relief but does not treat the underlying cause of pain
What is lithium chloride?
positive polarity used to treat gout and gouty arthritis
What are the pharmacotherapeutics of glucocorticoids?
prescribed for immunosuppression and reduction of inflammation and for their effects on the blood and lymphatic system
What is the frequency of shoulder subluxation and why is it significant?
present in 48.6% of patients significantly correlated with pain --> most painful and limited motion with external rotation and abduction
What are physical agents modalities?
procedures and interventions that are systematically applied to modify specific client factors when neurological, musculoskeletal, or skin conditions are present that may be limiting occupational performance use various forms of energy to modulate pain, modify tissue healing, increase tissue extensibilitiy, and decrease edema/inflammation
What is distribution of the drug?
process by which drug is delivered to tissues and fluids of the body affected by blood flow, solubility, and protein binding
What is wound contraction?
process of pulling entire wound together 14-21 days will be the most the wound will close on its own joint contracture can result from uncontrolled wound contraction
What is absorption?
progress of drug from time administered through the time to pass to the tissue until it becomes available for use by the body passive, active, and pinocytosis
What are some signs of infection?
prolonged or unusual inflammation yellow fibrin slough or necrotic tissue increase wound pain/tenderness foul odor
What is acute pain?
protective function to indicate tissue damage that lasts a short amount of time
What is an X cut?
provides moderate stimuli with focus of treatment in middle of tape and dissipates tension faster good for muscles with numerous attachments or muscles that have a broad origin and insertion
What is a Fan Cut?
provides treatment to broadest area least amount of stimulus good for edema management and digits
What is distraction in joint mobilization?
pulling apart of 2 surfaces used in combination with joint mobilization to increase stretch of capsule
What type of current is used for TENS? What are the different levels?
pulsatile current Levels: sub-sensory, sensory, motor, noxious, combination
What are the basic properties of electrical current?
pulse amplitude pulse duration
What is the biophysiolocial response to thermal application based on?
rate temperature is applied to the tissue duration of application volume of the tissue
What are some indications for contrast bath?
reduction of edema pain reduction impaired circulation treatment procedures must be closely observed for improving impaired circulation
What is drug potency? When is maximum effectiveness reached?
relative amount of drug required to produce a desired response maximum effectiveness is the point in which an increase in dose yields little or no increase in response
What is the application procedure for a hot pack?
remove from hydrocollator and wrap in 6-8 layers of dry towel apply to body segment and secure treat for 20 minutes check skin after 5 minues
What is the cryokinetic method?
repeated application of same cryoagent interrupted by sets of regular exercise during the treatment session
How does resistance change?
resistance increases at the cross sectional area of a conductor resistance decreases as the length of the area increases
What is acoustic impedence?
resistance of a medium to wave energy more dense or heavy the molecules, the greater the impedance and ultrasound reflection
What are the phases of tissue healing?
resolution, regeneration, repair inflammation, proliferation, maturation
What are the therapeutic goals when treating synergy patterns?
retrain the antagonist and initiate opposite patterns of movement
What is McConnell taping?
rigid tape used for bracing or strapping used primarily for orthopedics
What is sellar?
saddle one surface is concave in one direction and convex in the other, with the opposing surface concave and convex respectively
What are some contraindications for iontophoresis?
same contraindications for all forms of electrical stimulation skin sensitivity reaction sensitivity to aspirin gastritis or active stomach ulcer asthma sensitivity to metal sensitivity to seafood always ask about drug allergies and be aware of possible drug interactions
What is Brunnstrom Stage 4 for the hand?
semi-voluntary finger extension in small range of motion includes lateral prehension with release by thumb movement
What factors cause the pain gate to open?
sensory - injury, inactivity, drug use, body mechanics, pacing of activities (cycle of pain) cognition - focusing on pain, outside interest, worrying emotional - depression, anger, anxiety, frustration, hopelessness, helplessness
A phase duration of 20-150 usec will recruit what peripheral nerves?
sensory nerves through A-beta fibers over-rides pain by closing the gate
What is a roll in joint mobilization?
series of points on one articulating surface come into contact with a series of point on another surface roll occurs in direction of movement more congruent surfaces, the more sliding; more incongruent surfaces, the more rolling
What are the scapular stabilizers?
serratus anterior trapezius rhomboid major and minor pectoralis minor levator scapulae
What are some descriptors of neuropathic pain?
severe sharp lancenating stabbing ongoing numbness, tingling, weakness CRPS post-herpetic neuralgia radiculopathy
What is a third degree strain/sprain?
severe pain, loss of tissue continuity, decreased ROM, complete joint instability
What actions does C2, C3, and C4 responsible for?
shoulder girdle elevation
How do you treat the shoulder in the flaccid stage?
shoulder is prone to inferior subluxation and soft tissue damage and should be supported at all times functional electrical stimulation may reduce subluxation and enhance return of muscle activity
What are the disadvantages of a hot pack?
skin cannot be observed patient may no be able to tolerate treatment and weight weight can accelerate rate of heat being transferred passive treatment may not allow for AROM during heating period
What factors impact phonophoresis?
skin composition hydration vascularity skin thickness
What is skin lesion?
skin is the most frequent tissue injured healed by epidermal regeneration
How can drugs penetrate the skin?
skin openings provide entrance extending through the epidermis into the deeper dermal layer and are more permeable and proximal to vascular supply direct current to the skin can facilitate the movement of chemicals into the subcutaneous tissue
What is the role of C-fibers?
slow, chronic pain fibers
What kind of electric current is used for iontophoresis?
small levels of direct electrical current is used to facilitate movement of medications into the targeted tissue 0-4 mA
How do voluntary contractions work?
small motor nerves are recruited first and contraction increases in an asynchronous sequence allows for fine motor control, large fibers recruited as needed allowing for smooth, controlled movement
What is the role of A-delta fibers?
small, fast, protective pain fibers
What are the 3 pathologies of the shoulder?
soft tissue lesion impaired motor control altered peripheral and central nervous system activity
What is Brunnstrom Stage 4 of the upper extremity?
some movements that deviate from synergy placing the arm behind the back arm forward horizontal position pronation and supination with elbow at 90 degrees decreasing spasticity
What is a standing wave?
sound head is not consistently moved causing energy to summate and lead to periosteal heating
What is fluidotherapy?
special chamber that suspends finely ground cellulose particles in warm air to provide heat, massage therapy, and sensory stimulation simultaneously to result in counter irritation of pain
What is the bottom/up definition of function?
specific, discrete body impairment that affects larger daily life activities assessment focused on body impairment level pathology
What is secondary intention wound contraction?
spontaneous healing that follows 3 stages of healing
What is the latency stage of lymphedema?
stage 0 transport capacity is reduced due to injury but there are no visible or palpable signs of edema except for subjective comments prevention and early intervention focus
What does amplitude look like for re-education?
start with tetanic muscle contraction (twitch) and progress to muscle fasiculation to cue contraction of the muscle
What is the cryostatic method?
static application over treated area for duration of treatment session
What is isometric exercise?
static form of exercise in which a muscle contracts and produces force without an appreciable change in the length of the muscle and without visible movement includes static strength and endurance
What are the neurophysiologic effects of joint mobilization?
stimulates mechanoreceptors to decrease pain affects muscle spasm and muscle guarding increases awareness of position and motion due to afferent nerve impulse
What is NMES?
stimulates nerves that correspond to a targeted muscles to contract the tissue intact peripheral nerve, healthy muscle tissue are necessary for activation
What are bipolar electrodes?
stimulation uses electrodes placed at each end of the muscle belly
What are monopolar electrodes?
stimulation uses small active electrode with large dispersive pad
What is Klatenborn grade 3?
stretch involves actual stretching of soft tissue surrounding joint to increase mobility in hypomobile joints
What is a ligament sprain?
stretching or tearing of a ligament or joint capsule that stabilize and support the body's joints
What are pharmacodynamics?
study of the drug mechanisms that produce biochemical and physiologic changes to the body interaction at the cellular level between drugs and cellular components resulting in the drug effect
What are the indicators of superficial heating?
subacute/chronic inflammation subacute/chronic pain subacute edema removal decreased ROM resolution of swelling myofascial trigger points muscle guarding muscle spasm subacute muscle strain subacute ligament sprain subacute contusion infection
What is the significance of cytokines and chemokines?
substances that mediate healing and tissue regeneration while also changing the properties of the primary sensory neurons around the area causing hypersensitivity response from the spinal cord and brain
What are the goals of kinesiotaping?
support joints and muscles without restricting ROM benefit llymphatic system
What are the pharmacodynamics of glucocorticoids?
suppress redness, edema, heat, and tenderness associated with inflammation and suppresses the migration of polymorphonuclear leukocytes and inhibits phagocytosis
What are the shoulder muscular stabilizers?
supraspinatus deltoid latissimus dorsi
What is primary intention wound contraction?
surgical wound closure using sutures, adhesives, or staples
Your patient describes their pain as burning, pressure-like, aching, and stinging. What kind of pain is this?
sympathetic nerve pain
What is Brunnstrom Stage 2 of the upper extremity?
synergies can be elicited reflexively flexion before extension with spasticity developing
How would you tape for decreased strength?
tape for facilitation by stabilizing the join and promoting active range of motion
How would you tape for muscle overuse?
tape for inhibition to decrease pain and increase AROM within the normal range
What is the theory behind kinesiotape?
tape is applied unstretched over manually stretched skin above the injured muscle causing the skin to form convolutions convolutions encourage regeneration of injured tissue by increasing interstitial space and alleviating interstitial pressure that occurs from swelling post injury increased space gets rid of fluid and decreases pressure on nociceptor to decrease pain facilitates fluid leaving space with pain causing chemokines and bradykinens to leave the area
How would you tape for edema?
tape is positioned to recoil and promote drainage toward health lymph node
What is the kinesiotaping method?
taping method designed to facilitate the body's natural healing process while allowing support and stability to muscles and joint without restricting the body's range of motion used as an adjunct to and in conjunction with other modalities and activity and movement
What are common diagnoses and uses of soft tissue mobilization?
tendinopathies muscle imbalances scar management traumatic and acute injuries performance enhancement
What is a muscle/tendon strain?
tendon is stretched 5-8% beyond normal limit causing tendon to develop a tear
What are the principles of examination?
test normal side first AROM, PROM, then MMT painful area should be assess last ligamentous tests applied gently and repeated use PAM to relax patient AFTER
Where is the highest concentration of drug during iontophoresis?
the tissue closest to the electrode/treatment site
What is phonophoresis?
therapeutic application of ultrasound with a topical drug to promote direct drug delivery to the site
What is McConnel taping?
therapeutic tape bracing technique used for neuromuscular re-education
What is kinesiotaping?
therapeutic taping technique over and around muscles to provide support, prevent over-contraction while allowing full ROM and normal biomechanics and facilitating lymphatic drainage and decreased pain by lifting skin and relieving pressure
What are the oncology rehabilitation programs?
therapy programs that address the unique needs of patients with cancer include rehabilitation post-surgery, rehabilitation during and post chemotherapy, radiation therapy, and hormone therapy, lymphedema management and prevention program, and pre-hab
What is paraffin bath?
thermostatically controlled tank that mixes paraffin wax and mineral oil at 125 degrees to effectively treat distal extremities applied at moderate to vigorous dosages to decrease stiffness and pain in joints, reduce pain in soft tissues, and improve ROM
What is Maitland grade 5?
thrust technique manipulation with small amplitude and quick thrust at end of range accompanied by popping sound velocity vs. force
What action is C8 responsible for?
thumb extension
What is Klatenborn grade 2?
tighten separates articulating surfaces, taking up slack or eliminating play within joint capsule used initially to determine joint sensitivity
What is the onset of action?
time interval that starts when the drug is administered and ends when the therapeutic effects actually begin varies depending on the route of administration and other pharmacokinetic properites
What is central sensitization?
tissue injury that leads to changes in spinal excitability which elevates spontaneous firing due to decreased threshold and expanded receptive fields fundamental to prolonged pain sensitivity with chronic pain
What is the general healing response?
tissue is injured blood flows to injury site platelets contact collagen and extracellular matrix histochemical changes - cytokines cause pain platelet release clotting factors
What are some reasons for taping?
tonal changes decreased strength muscle overuse edema postural changes pain bruising
What is transport capacity?
total amount oflymph the lymphatic system can handle
What is a glide/slide in joint mobilization?
translational specific point when one surface comes into contact with a series of points on another surface more congruent surfaces the more sliding; more incongruent surfaces the more rolling
What are the muscles responsible for scapular alignment?
trapezius serratus anterior rhomboids
What are soft tissue injuries?
trauma or overuse of structures that occurs to muscles, tendons, or ligaments depends on causative factors, location, and material properties of the tissue
What is the role of OT working with oncology patients?
treat impairments associated with cancer surgery and treatment to improve ability to participate in desired occupations scar adhesion, fascial cording, muscle imbalances, ROM deficits, postural re-education, scapular dykinesia, lymphedema, decreased strength and activity tolerance
What are some contraindications for contrast bath?
treatment following acute injuries hypersensitivity to the cold other contraindications relative to cryotherapy and thermotherapy
What is manual resistance exercise?
type of active resistance exercise in which resistance is provided by therapist amount of resistance is limited only by the strength of the therapist
What is pain?
unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage
What are electrotherapeutic agents?
use electricity and electromagnetic spectrum to facilitate tissue healing, improve muscle strength and enducarnce, decrease edema, modulate pain, decrease inflammatory process, modify the healing process ex. neuromuscular electrical stimulation (NMES), functional electrical stimulation (FES), transcutaneous electrical nerve stimulation (TENS), high voltage galvanic stimulation (ESTR), high voltage pietsid current (HVPC), iontophoresis
What is interferential current (IFC)?
use of 2 leads generated on separate channels that combine/interface to produce a frequency deeper form of TENS current permeates to greater depth and over a larger volume of tissues capacitive skin resistance decreases as pulse frequency increases
What are pharmacotherapeutics?
use of drugs to treat disease type of therapy depends on the severity, urgency, and prognosis of the condition
What is compression bandaging?
use of multi-layer bandaging and compression garment reduces ultrafiltraton, improves efficiency of muscle pumps, prevents accumulation of evacuated lymph fluid, helps break up accumulated scare and connective tissue
What is the significance of PAMs?
used as a preparatory method to treating a variety of neuro-musculoskeletal movement and sensory function should be adjunctive to occupational performance
What is atheltic taping?
used for acute injuries or to prevent them no rehabilitative benefits
What is a donut/button hole cut?
used for areas with bony prominences, to avoid wounds, broken skin, or incisions, and used for painful edematous areas
What is athletic taping?
used for instability, acute injuries, and injury prevention rigid tape used to compress the skin, joint, and muscle to limit motion results in obstruction of blood flow of bodily fluids, does not promote healing, and may have undesirable side effects
What is an amplitude ramp?
used in TENS gradual rise and/or fall in amplitude of a pulse train causes a gradual increase in the force of muscle contraction by progressive recruitment of motor units
What is muscle energy?
used in an active contraction of deep muscles that attach near the joint and when line of pull can cause the desired accessory motion clinician stabilizes segment of distal aspect of muscle attaches, commands for an isometric contraction which then causes accessory movement of the joint
What is early motion exercise?
used in the inflammation phase healing tissues should not be stressed and early motion is utilized to inhibit pain and muscle guarding to help prevent deleterious effects of complete immobilization usually PROM applied in pain free range AAROM if tolerated
What is an I cut?
used on one tissue for localized treatment and high stimuli
What is Maitland grade 3?
used ot gain motion wihtin the joint and stretch capsule and connective tissue structures with large amplitude rhythmic oscillating movement up to point of limitation in range of movement
What is noxious level stimulation for TENS?
used prior to passive stretching, debridement, or mino surgery amplitude is increased to perceive painful level and turns on teh opiate control system pulse duration: 1 ms - 1 sec frequency: 1-5 > 100 pps
What is Maitland grade 4?
used to gain motion within the joint when resistance limit movement in absence of pain with small amplitude rhythmic oscillating movement at very end range of movement
What is Maitland grade 2?
used to manage pain and spasm with large amplitude rhythmic oscillating movement within midrange of movement
What is Maitland grade 1?
used to manage pain and spasm with small amplitude, rhythmic oscillating movement at the beginning of range of movement
What is iodine used for?
used to manage scar tissue with sclerolytic properties that reduce scar tissue and increase tissue extensibility
Your patient describes their pain as throbbing and diffuse. What kind of pain is this?
vasculature
What is cording/axillary web syndrome?
visible or palpable tight cords that become more pronounced and painful with shoulder abduction treatment includes soft tissue work with gentle myofascial release, scar tissue massage, AROM/AAROM of shoulder and elbow
What is Brunnstrom Stage 6 for the hand?
voluntary mass finger extension with variable ROM
What is superficial heating?
warming of tissue to reduce pain and inflammation through analgesic effect that is recommended in sub-acute conditions
What are symptoms for differential diagnosis?
what the patient reports as their medical complaint subjective comments
What is LOCIDAA?
what you should think about during an evaluation Location Onset Characteristics Intensity Duration Aggravating factors Alleviating factors
What is peak concentration?
when absorption rate equals the elimination rate not always at the time of peak response
What actions is C7 responsible for?
wrist extension
What is current density?
0-4mA determines whether current flow is safe and comfortable and should be based on patient's tolerance and comfort rather than speed of treatment delivery lower levels of current density prevents skin irritation or burning
What is the inflammatory phase?
0-72 hours neutrophils enter wound site and process of phagocytosis begins to remove foreign material, bacteria, and tissue process is continued by macrophages blood vessels dilate in response to histamine release blood and serous fluid influx cause red, hot, swollen painful area as body works to compartmentalize the wound into one area phase ends when wound is clean
What is the maturation phase?
1-2 years post injury goal is to influence scar formation by applying controlled stress as scar matures preferred outcome is a dense, parallel union of scar tissue
What does examination look like before treatment?
1. if pain is experienced before tissue limitation, gentle pain-inhibiting joint technique may be used with no stretching 2. if pain is experienced concurrently with tissue limitation, the limitation is treated cautiously with gentle stretching 3. if pain is experienced after tissue limitation is met because of stretching of tight capsule, joint can be stretched aggressively
What is the therapeutic range of temperatures for thermal treatment (heat)?
104-113 degrees
What are the frequency parameters for NMES?
15-25 pps for weak/deconditioned patients 35-75 pps for otherwise healthy patients - increases muscle firing rate 50 pps to fatigue spastic muscles
What is the clinical delivery model for iontophoresis?
4mg/mL deliverd at maximum amplitude of 2 mA will take 20 minutes treatment delivery and will be comfortable and safe for the client 40-80 mA/min (dosage) can be delivered in treatment period of 10-40 minutes depending on current density
What is the proliferation phase?
6 weeks resurfaces and builds strength to the wound through epitheliazation, wound contraction, and collagen production
What are the frequency parameters for TENS?
60+ pps for pain relief
At what temperature do changes begin to occur with cryotherapy?
80.6 degrees reversing takes 30 minutes
What has more acoustic impedence? Fluid or bone?
Bone - highest impedances values and highest acoustic absorption leading to more physiologic effects Fluid - lowest impedence values and acoustic absorption leading to less physiologic effects fat - water - blood - muscle - bone
What is electrical muscle stimulation?
EMS use of a direct current for denervated muscles
What states require special PAMs licensing?
Florida New York Illinois Nebraska South Dakota California Montana New Hampshire New Jersey Georgia Maryland Kenntucky Tennessee
What should treatment of shoulder pain look like?
It depends on the stage of recovery (flaccid or spastic) proper positioning of the shoulder ROM activities avoidance of immobilization
What is neuromuscular electrical stimulation?
NMES uses alternating current for innervated muscles
Can you use other physical agents with iontophoresis?
NO may be counter productive due to increased blood flow and accelerated removal of medications (heat) or increased viscosity that inhibits drug permeability (cold)
