Test 2 formalities of therapeutic modalities

Chapters 7-9

What is the overall purpose of injury repair?

To replace dead or damaged cells with healthy cells when possible.

Why can a new scar look red and raised?

Early scar tissue has increased vascularity and increased collagen.

How long can collagen restructuring/remodeling continue?

Up to one year

During which phase do macrophages migrate into a wound?

Hemostasis and inflammation.

When is most collagen laid down after an injury?

Approximately 15–20 days after injury.

Compare reconstitution and replacement.

Reconstitution occurs in cells with a high rate of turnover, such as skin; replacement occurs in cells with a lower rate of turnover, such as muscle.

What interventions can modify healing?

Immediate care procedures, quickly closing lacerations, therapeutic exercise, therapeutic modalities, and proper nutrition can all influence healing.

Define pain

A subjective sensory and emotional experience associated with actual or potential tissue damage

What is the evaluative quality of pain?

The component involving conscious thought processes.

What is a useful core philosophy of pain management?

Avoid focusing on only one aspect of pain, use theory to guide treatment, and use a broad approach to improve the chance of relieving pain. Therapeutic tools are not more important than theoretical principles.

How should therapeutic exercise feel when it is being used to help relieve pain?

It should be relatively pain-free or only mildly uncomfortable.

What does the neuromatrix theory propose about pain?

Pain is a biopsychosocial event produced by nerve impulse patterns generated by a widely distributed neural network in the brain.

What is the placebo effect in the context of pain?

Improvement can occur without an active treatment and may involve changes in pain-sensitive regions of the brain. Measured pain relief specifically caused by an active therapeutic modality is not a placebo effect.

According to Dehne's spinal adaptation syndrome principle, what can nociceptive impulses from traumatized tissue do?

They can inhibit motor functions and tissue repair.

What does specificity theory say about pain?

Pain results from excitation of specific peripheral nerve receptors associated with painful stimuli.

Which theories recognize pain receptors that respond to painful stimuli?

Specificity theory and gate control theory.

What is the central idea of gate control theory?

Competing sensory input can influence whether pain information is transmitted toward the brain; the model describes a spinal 'gate' that modulates transmission.

What happens with large-fiber input in the gate control model?

Large-fiber input can activate the substantia gelatinosa (SG) cell and inhibit pain transmission.

Which inputs participate in summation at the SG cell?

Both small- and large-fiber impulses.

What kinds of summation occur at the T cell?

Both spatial and temporal summation.

What is temporal summation?

Repeated subthreshold stimuli arriving one after another before the effect of the previous stimulus dissipates.

Where are previous experiences represented in the gate control model?

Central Control

Where does central control influence activity?

At the cell

How can a skin irritant such as a topical counterirritant relate to gate control?

Nonpainful or competing cutaneous sensory input can increase large-fiber activity, activate inhibitory gating mechanisms in the spinal cord, and reduce transmission of pain signals toward the brain.

From which horn do efferent (motor) nerves exit the spinal cord?

The anterior horn

Know the nerve-fiber order from largest to smallest.

A-alpha → A-beta → A-gamma → A-delta → C.

What is meant by a threshold stimulus in pain physiology

The minimum stimulus intensity needed to trigger an action potential. Note: the exam item itself keyed 'None of the above' because 'threshold' was not among its listed choices.

What is enkephalin?

An endogenous opioid-like substance; the keyed exam identifies enkephalin as the morphine-like substance described.

How can electrotherapy reduce pain?

Mechanisms emphasized include stimulating nonpainful nerves to modulate pain, promoting endogenous opioid effects, and decreasing muscle spasm.

Which proposed electrotherapy effect was NOT identified as a pain-reduction mechanism on the test?

Reducing capillary hydrostatic pressure to decrease edema.

What should you be able to trace from an injured ankle to the CNS?

A sensory/pain impulse beginning at peripheral receptors, traveling through an afferent sensory neuron toward the spinal cord, entering the CNS through the sensory/dorsal side, synapsing and ascending through CNS pathways toward higher centers where the information is processed.

What should a strong pathway explanation include?

Where each pathway segment begins and terminates, rather than only naming structures.

Phases of wound healing

Inflammatory phase

Proliferative phase

Remodeling/maturation phase