Passive Care- Exam 1- Introduction to Passive Care, Stages of Healing , Electrical Stimulation Terminology

What is an EPA?

ElectroPhysical Agents

What are some examples of an EPA?

Electric stimulation

Heat therapy

Cold therapy

Mechanical energy

Light

TRUE or FALSE

Electrophysical agents are complementary to a chiropractic adjustment

TRUE

-they are rarely the sole therapeutic intervention

A large majority of cases we see as chiropractors involve_________issues

Musculoskeletal

What kind of care is it when the doctor applies the intervention to the patient?

Passive care

What kind of care is it when the patient passively receives the therapy?

Passive care

What kind of care is it when the patient has to perform some sort of activity or exercise to achieve a therapeutic effect?

Active care

You should start with more ___________ care and as the treatment plan goes on you should switch more to ________

Passive to active

What are the 4 stages of healing?

1. Hemostasis

2. Inflammatory

3. Proliferation

4. Remodeling/maturaion

What are the phases of healing that we have an impact on?

Inflammatory

Proliferation

Remodeling/Maturation

What stage of healing is in seconds to minutes and is the initial blood clotting to stop the bleeding?

Hemostasis

What stage of healing is hours/days/weeks?

Inflammatory

What stage of healing is weeks/months?

Proliferation

What stage of healing is months/year?

Remodeling/maturation

TRUE or FALSE

The cause of the injury doesn't change the healing process

TRUE

TRUE or FALSE

The timing of the healing varies

True

What are things that can cause timing differences in the healing process?

Tissue type

Severity

Overall health

What is known as the acute phase?

Inflammatory phase

The inflammatory phase is ______to ________

Immediate to a few days

Inflammatory phase is ________but________

Essential but too much can be bad

What type of tissue wont heal well?

Avascular or poorly vascularized

What is the purposes of the inflammatory phase?

Defend against foreign intruders (infection)

Remove damaged tissue and debris

Immobilize area

What are the 5 signs of inflammation?

Heat

Redness

Swelling

Pain

Loss of function

Inflammation stage is characterized by what 3 things?

Vasodilation

Increased capillary permeability

Phagocytosis by neutrophils and macrophages

What inflammatory chemicals cause pain?

Bradykinin

Prostaglandins

Serotonin

How does ice help decrease inflammation?

Decrease temp= decrease enzyme activity and metabolism = decrease inflammation

TRUE or FALSE

Too much inflammation can be bad

TRUE

During a secondary enzymatic injury, ___________ enzymes are released, it is not _________ and ________ tissue is damaged

Lysosomal

Not specific

Heathly

What are some examples of a secondary hypoxia injury?

Hemorrhage

Clotting

Edema

Spasm

Hematoma

Secondary hypoxic injury leads to decreased _____ and _______ with damage to_____________

Oxygen and nutrition

Surrounding uninjured tissues

What are the 2 main goals of the inflammatory phase?

Limit extent of inflammation but not fully prevent it

Preserve ROM

When is PRICE okay to be used?

First 24 hours of passive care done

What is PRICE?

Protect

Rest

Ice

Compress

Elevate

You should rarely ice beyond what time frame?

Beyond 72 hours

You should only do an inch bag, ice bath, gel packs, etc. for how long?

24-48 hrs

What will delay muscle hypertrophy?

Icing immediately after heavy lifting exercise

What is known as the repair phase?

Proliferative phase

What occurs during the proliferative phase?

Angiogenesis= new capillaries

What type of collagen is put down during the proliferative phase?

Type III collagen

Describe type III collagen

Weak

Disorganized

Beginning cross-linking

What other things are involved in the proliferative phase?

Fibroblasts, chondroblasts, osteoblasts

Proteoglycans

What are the goals of the proliferation phase?

Decrease swelling

Decrease pain

Increase pain free range of motion

Begin NON-WEIGHT BEARING proprioceptive training

Encourage and increase proliferation ( proliferate the proliferation)

What happens to proprioception after an injury?

Goes away for a bit

-why sometimes the ankle for example it's unsteady after spraining

What is important to avoid during the proliferation phase?

What is okay to use?

NO ICE

-okay to use heat

What is known as the maturation phase?

Remodeling phase?

When can scar contraction occur? What can it lead to?

Remodeling phase (maturation phase)

-can lead to joint adhesion and loss of motion

What occurs during the remodeling phase?

Type III collagen is replaced by Type I

There is a decrease in__________ during the remodeling phase

Blood vessels

What are the goals of the remodeling phase?

Increase pain free ROM

Progress proprioceptive training

Regain full strength

Normal biomechanics

Protect and strengthen and residual joint instability

What encourages the replacement of Type III collagen by Type I collagen during the remodeling phase?

STRESS

- on the tissue in the way the tissue is used

Tension on connective tissue causes increased what 4 things?

Collagen fibril diameter

Cross linking

Number of collagen fibrils

Collagen fibril packing density

When collagen fibers are aligned in a ___________ fashion it forms the greatest number of cross links and possesses optimal strength

Parallel

During the remodeling phase of healing it should be more (active or passive care)?

Active care

What are the physiologic effects of electrical stimulation?

Decrease pain

Decrease muscle spasm

Reduce edema

Stimulate exercise by muscle contraction

Stimulate healing

What does electrical stimulation stimulate exercise by muscle contraction?

Increase muscle fiber recruitment

Retard atrophy

What is the flow of electrons through a conductor?

Electricity

What is the number of electrons?

Current

What is the potential energy of electricity?

Voltage

What are some examples of resistance for electricity?

Length of conductor

Cross sectional area

Temperature

You have the lease amount of resistance when?

Short smooth large diameter wire

When you have too small of a wire, it increases resistance and with that it produces?

Heat

-why electrical fires can happen

What is the ability of a material to store a charge?

Capacitance

What is current flow in one direction/

Monophasic current

A monophasic current has both unique _________ and _____________

Positive and negative electrodes

What the name for monophasic current?

Direct current (DC)

-kind in the battery

What is the AKA for direct current (monophasic current)?

Galvanic

The net charge for monophasic current has both a ________ and _______ electrode with charge that builds up in the _______

Positive and negative electrode

Builds up in tissue

For monophasic current if it starts positive than? What about negative?

Starts positive, stays positive

Starts negative, stays negative

What is more dangerous, monophasic or biphasic current?

Biphasic current

What is biphasic current called?

Alternating current (AC)

What occurs with biphasic current (alternating current)

Flow of electrons changes direction regularly

What wave form is the same shape in both phases for alternating current?

Symmetrical

What wave form is different positive and negative for alternating current?

Asymmetrical

What net charge for alternating current is equal electrical charge in both phases?

Balance

What minimize or eliminate the polarity effect in the tissues during alternating current?

Balance net charge

What is an unequal charge for net charge of alternating current?

Unbalances

What are the different types of shape that biphasic (alternating current) can be?

Sinusoidal

Square

Rectangular

Triangular

Different ______ are used for different therapy's using biphasic current

Shapes

What is the phase duration?

Time it takes current to leave the isoelectric line to when it returns to this line

For biphasic phase duration, there are _____________ for each pulse

Two phase durations

For monophasic phase duration, the ________________

Phase duration and pulse duration are the SAME

Tissues response to _____________ NOT __________

Phase duration NOT pulse duration

A phase duration must be long enough to?

Overcome capacitance and cause an action potential

Large diameter nerves have a __________ capacitance and reach threshold ____________

Low

Quickly

What is the intensity or magnitude of the current?

Amplitude

What is the maximum amplitude of the current regardless of duration?

Peak current

What type of nerve fibers are close to the skin and have a lower threshold so will be stimulated first?

A-beta fibers

High peak current is associated with _____________

Greater depth of penetration

What is the amount of current supplied over a period of time/

Average current

Average current takes what into consideration?

Peak amplitude and the phase duration

What describes the relationship between amplitude (strength) of the electrical current and the duration (Phase duration)?

Strength duration curve

What will happen if the charge is sufficient to overcome the capacitance of a nerve?

It will depolarize

If the charge does not exceed the capacitance of a nerve fiber, what will happen?

No depolarization will occur

What was capacitance?

Ability of material to store charge

What fibers are targeted when the patient reports tingling but no muscle twitch?

Exceeded A-beta fibers but not A-alpha motor neurons

What fibers are activated when there is a muscle contraction?

A-alpha motor neurons have been exceeded

What fibers are activate when the patient reports burning, needling sensation?

Exceeded the A-delta fiber capacitance

What is the minimum amplitude needed to depolarize a nerve fiber when phase duration is infinite?

Rheobase

What will happen if peak amplitude fails to exceed rheobase?

Nerve will not depolarize regardless of phase duration

What is the time (or phase duration) required to depolarize a nerve fiber when the peace current is twice rheobase?

Chronaxie