EPA Exam 1

DTQ: definition of pain

an unpleasant sensory and emotional experience associated with actual or potential tissue damage

perception threshold vs tolerance threshold

perception = how much input does it take for you to perceive pain; tolerance = how much pain you can tolerate

Acute vs chronic pain

acute = pain w/ a purpose, alerts to damage, days/weeks ; chronic = no biological purpose, months/years, poor response to treatment

4 categories of pain

nociceptive (somatic vs visceral), neuropathic (peripheral vs central), psychogenic, carcinogenic

which category of pain do electro physical agents work for

somatic pain

Why referred pain happens

no direct path from viscera to brain, they converge with somatic nociceptors

Allodynia

all sensory input is perceived as pain

Hyperalgesia

a little bit of pain is perceived as a lot of pain

5 phases of pain perception

transduction, peripheral transmission, modulation, central transmission, perception

Modulation: GATE Theory general concepts

touch inhibits pain, touch activates SG which modulates pain

when SG is ON vs when SG is OFF

ON = LESS pain, less touch ; OFF = MORE pain, more touch

Pain cycle

pain -> spasm -> ischemia -> dysfunction

DEOS (descending endogenous opiate system)

internal painkiller, released when experiencing a lot of pain, pain inhibits pain

DTQ: what does the pain sensitization graph show us

shows difference between allodynia and hyperalgesia

peripheral vs central sensitization

peripheral = @ peripheral nerves, inflammatory, can use EPAs ; central = @ cortex/SC, allodynia, want to get rid of acute pain early

3 most important WBCs of inflammation and their function

Macrophages = garbage eater, Neutrophils = kill bacteria, Basophil = produce histamine (vasodilation)

3 cells on SS Histamine and their function

Mast cells = release histamine ; Platelets = form clots, produce histamine ; Fibroblasts = eat calcium, spew collagen, produce histamine

DTQ: T or F, fibroblasts hang out in connective tissue

true

3 phases of healing

inflammatory (want to speed up), fibroblastic, remoldeling

DTQ: what creates histamine

mast cells, platelets, basophils

DTQ: Read article for 1st exam on D2L (Cameron, 2003)

alr did jit

PT goals during inflammatory phase

protect area and prevent inflammation from getting out of hand (EPAs: cryo, pulsed US, STM)

EPAs during fibroblastic phase

E stim makes skin cells more active, US makes fibroblasts more active thus increasing collagen production (use other EPAs to break up adhesions)

contracture happens why

uncontrolled activity if myofibroblasts which spew collagen and pull edges of wounds together

Remodeling phase goal

get collagen fibers all in 1 direction

keloid scar

too much collagen production, use compression or low O2 environment

which tissues heal fastest? Rank 1-5 (cartilage, muscle, tendon/ligament, skin, bone)

1. skin, 2. muscle, 3. bone, 4. tendon/ligament, 5. cartilage

some factors that affect wound healing

smaller wounds = faster, surgical wounds = faster, EPAs = faster, old age = slower, diabetes = slower, steroids & NSAIDS = slower

main points of cryotherapy

removing heat from the body, causes vasoconstriction, can be conduction and convection

ways to improve cryotherapy conduction

more temp difference, more time, thermal conductivity (wet washcloth)

cryotherapy and muscle strength

can increase muscle strength immediately after application, but long application = decreased muscle strength (vasoconstrict)

indications for cryotherapy

acute trauma, pain, muscle spasm, spasticity

contraindications for cryotherapy

cold allergy, Raynaud's, circulatory compromised, regenerating nerves

main points of thermotherapy

heat it up and do something with it, therapeutic range <113 degrees, vasodilation

ways to improve thermotherapy conduction

time, temp gradient, insulator (dry towel), body weight resting on it

hot pack treatment regulations

8-12 layers in between, 10-15 minute treatment, give them a bell, check skin

DTQ (know temp of 120): why can we stick our hand in paraffin wax that is 120 degrees and not water that is 120 degrees

paraffin has a lower conductivity and specific heat than water

thermotherapy effects

vasodilation, allows for more stretch (GTO), decrease pain, heated hemoglobin = more O2 delivery

thermotherapy indications

pain, stiffness, speed up healing (apply heat after inflammatory stage)

DTQ: Pt has hotpack on back laying prone with 8-12 layers, you check in 5 minutes and Pt reports feeling no heat, what do you do? (A = call 911, B = check skin, C = check skin and remove some towels)

C = check skin and remove some towels

thermotherapy contraindications

acute injury/inflammation, thrombophlebitis, cancer, pregnancy

soft tissue mobilization (STM) therapeutic purposes

break adhesions, decrease pain, promote flow, relaxation

DTQ: sequencing of STM

start light, go deeper, end light

STM indications

MSK dysfunction, neuro conditions, vascular/lymph disorders

STM contraindications

cancer, thrombophlebitis, acute trauma, pregnancy, over open wounds,

DTQ: what are the 3 components of fascia (shock absorber)

elastic component (stretchable), collagen component (rigid), gel

Ultrasound how it works

piezoelectric crystal inside applicator that oscillates and converts energy to heat up tissue

transduction of energy in ultrasound

electrical -> mechanical (crystal) -> sound -> thermal

Effective radiating area (ERA)

treatment area should be no larger than 2x ERA

Ultrasound frequency (1 vs 3 mHz)

1 mHz goes deeper but has less energy, 3 mHz less deep but more energy

why we should keep the ultrasound applicator perpendicular to the skin

if not the rays refract and heat up the skin and not the tissue

Beam Nonuniformity Ratio (BNR)

peak intensity/average intensity, how spread out the energy is through the transducer, way it to be low ratio

Standing waves

why we need to keep applicator moving, wave can reflect back to transducer and produce a lot more energy than intended, be careful over bone or metal

Duty cycle

time ON / time ON + time OFF, shows how much the US is pulsing, pulsed US can be good acute injury

DTQ: what is the duty cycle if the US is ON for 2 ms and OFF for 8 ms

2/10 (20%), low heat for acute injury bc inflammation

units of BNR, Frequency, ERA, Intensity

BNR = none, Frequency = mHz, ERA = cm^2, Intensity = W/cm^2

DTQ: how to deliver more energy for US?

raise intensity, time, frequency, duty cycle (make it continuous)

DTQ: which US delivers the most energy (A = 3 mHz, 1.5 W/cm2, 100% Duty cycle, 8 minute) (B = 1 mHz, 1.5 W/cm2, 100% duty cycle, 8 minute) (C = 3 mHz, 0.5 W/cm2, 100% duty cycle, 8 minutes)?

A

why we use gel for ultrasound

bc US doesn't travel through air, needs a medium, gel does impedance matching

effects of US

heat up tissue, decrease pain, reabsorb calcium deposits, cavitation, microstreaming, mast cell degranulation

cavitation

US makes air bubbles that attach to fibroblast membrane and make it more permeable

microstreaming

US surfs calcium along fibroblast membrane making it more permeable

DTQ: when US on knuckles, what concerns you more, applicator having BNR 12:1 or ERA 1 cm2

BNR 12: 1

DTQ: what type of applicator do you need for knuckles?

a small one (can use cushion for uneven areas)

phonophoresis

using US to increase skin permeability, so topical meds can penetrate skin easier

US contraindications

cancer, pregnancy, thrombophlebitis, pacemakers, gonads, ischemia

laser key points

lasers have all the same wavelength and do not disperse, laser increases ATP production

DTQ: what is a chromophore?

a cell whose activity changes in the presence of light/laser (mitochondria)

DTQ: pain generators of back pain

muscle, facet joints, ligaments, intervertebral discs, nerve root

how traction helps herniated discs

the negative pressure can pull the prolapsed disk back in/start the healing process

effects of traction

distraction of vertebral bodies (slightly), gliding of facet joints (gate theory), stretch ligaments & muscles, increase foramen size

indications for traction

disc bulge (continuous traction), narrowing of foramen, nerve swelling, facets stuck (intermittent traction)

contraindications for traction

acute injury/inflammation, osteoporosis, pregnancy, cancer, spondylolisthesis, TMJ issues

vertebrobasilar insufficiency

test you do before traction to see if neck vessels are flowing good enough

DTQ: how to isolate the upper cervical and lower cervical during traction

upper cervical angle of pull = 0 degrees, lower cervical angle of pull = 30 degree flexion

DTQ: clinical practice guidelines for traction - 4 criteria

FABQW < 21, no neuro deficit, older than 30, desk job

effects of aquatic therapy

hydrostatic pressure causes increased venous return, causing increased CO & SV, so decreased HR

DTQ: temperature cutoff for aquatic therapy

90 degrees

DTQ: contraindications for aquatic therapy

sensory/mental impairment, wound, pregnancy, incontinence, bad CV disease