Passive Care Final Exam: CONDENSED

What is fluid contained by the joint capsule and feels like a water balloon, moving when palpated and then returns?

Joint effusion

What is when fluid is within the interstitial space and when you press on it, it dents or pits and remains pitted for a while?

Edema

What is the treatment strategy for acute injury?

PRICE (RICE)

What does RICE stand for? PRICE? PRICES?

Rest

Ice

Compress

Elevate

PRICE = + Protection

PRICES = + Protection & Support

What are the 3 purposes of compression?

1) Decrease edema

2) Stop any bleeding

3) Give mechanical support

What type of compression is the wrapping of elastic wrap from distal to proximal, wrapping tighter distally and looser proximally?

External compression

What is something that is firm but compressible (felt or foam) applied under the compression wrap to increase the amount of compression (TQ)?

Buttress

What is compression of veins and lymph vessels through muscle contraction, where it moves fluid proximally from the limbs?

Internal Compression

What are 2 results of external compression?

1) Moving fluid proximally toward the heart

2) Moving arterial blood distally into an extremity

What type of compression is with a mechanical devise (usually pnematic) that is worn over the extremity, so the pressure is increased sequentially in various compartments of the garment (distal, middle, proximal) to move fluid proximally?

Intermittent compression

What is intermittent compression used for?

Acute and chronic edema

What is a collection of large-diameter veins on the bottom of the foot, and when you walk you alternately compress them, increasing blood flow up the calf?

Plantar venous plexus

T/F: Compression is good for patients with a pulmonary embolism

TRUE

-- compression of LE can be both therapeutic and prophylactic

What is elevation good for?

Gravity causes fluid to move from distal to proximal in the limb

What provide support or assistance when the patient is unable to walk or bear weight on an extremity, providing localized rest to a lower extremity?

Ambulatory aids

When fitting a pair of crutches, the patient should wear ___________ shoes. The crutch tips should be ____" in front of the shoes and ____" to the sides of the shoes. The arm brace should be ___-___" below the anterior axillary fold. The elbow should be flexed to ______ degrees with the hands on the hand braces.

Low-heeled shoes

crutch tips 2" in front & 6" to the sides

Arm brace 1-2" below anterior axillary fold

elbow flexed 30 degrees

What is numbness and paresthesia of the hands due to compression of nerves in axilla by the crutch arm brace?

Crutch palsy

What is the crutch gait for full non-weight bearing of a lower extremity?

Tripod gait (w/ either swing to or swing through)

What crutch gait is used when the patient is coordinated enough to swing their weight forward 12-15 inches past the crutches?

Swing-through gait

What crutch gait is used when the patient isn't coordinated enough to swing through, so the patient swings the body just up to the crutches, not beyond?

Swing-to gait

What crutch gait is used for partial non-weight bearing of the lower extremity?

Four-point gait

(tripod gait for partial non-weight bearing)

What is the recommended method for going up and down stairs with crutches?

Hold hand rail w/ one hand and use both crutches under the other arm

When fitting a cane, it should be at the height of the _________________ and held in the hand _______________ to the bad lower extremity.

Greater trochanter

Held in hand OPPOSITE

How are scoliosis braces categorized?

By the regions they support (cervical, thoracic, lumbar, sacral)

How are scoliosis braces usually worn (how long throughout the day)?

23 hours a day

(1 hour off to shower, ect)

How is Boston Brace categorized?

TLSO

(thoraco-lumbo-sacral orthosis)

How is the Milwaukee brace categorized?

CTLSO

(cervico-thoraco-lumbo-sacral orthosis)

What scoliosis brace is used for a single curve of the thoracic spine?

Boston Brace

What scoliosis brace is used for double curve of thoracic and thoracolumbar spine?

Milwaukee Brace

What brace is worn only at night due to it being molded into an extreme laterally bent position?

Charleston Bending Brace

What 2 braces are worn for compression fractures, keeping the spine in neutral or extension posture preventing flexion and further compression of the broken segment?

Voight-Bahler & Jewett braces

What brace is used to compress the SI joints to stabilize them externally for sprains or in SI joint instability (ex: pregnancy)?

SI belt

What happens if a sacroiliac joint belt is worn low (over the trochanters)?

Causes instability of SI joints by causing gapping of the joints

What is the shape (form) of the joint causing the joint to be inherently stable?

Form Closure

What is it when the joint is stabilized externally such as with muscle contraction forcing the joint closed?

Force Closure

T/F: Those who have never been injured can get an increase in protection if they wear a back belt as it decreases the intra-abdominal pressure and blood pressure, but they do give the impression that a patient can lift more which is risky as some people lift with better mechanics while others with worse

FALSE

Those who have never been injured get NO protection

-- may have even more severe injuries

INCREASE intra-abdominal pressure & bp

Rest is TRUE (impression of lifting more = risky; some lift better mechanics some get worse)

What brace/support should be considered temporary, patients should be screened for CV risk, they must be in combination with education to train the patients to use good lifting mechanics, and the patient should be placed in comprehensive fitness and education programs?

Back Belt

What brace/support helps patients feel subjectively more stable although they aren't objectively more stable, and they may not protect from injury as they actually slow hamstring reflexes which puts the knee at risk for injury?

Knee braces

What brace/support keeps the joint warm, compresses the joint which may help for swelling, is not effective for preventing injury, and may improve proprioception?

Elastic sleeves

What brace/support is for compressing the patellar tendon in Osgood Schlatter's disease and compressing the wrist flexor and/or extensor tendons at the medial/lateral epicondyles (epicondylitis)?

Cho-Pat straps

What brace/support is for fractures and severe sprains of the lower leg?

Walking boot

What brace/support is used to prevent inversion and eversion but allow plantar flexion & dorsiflexion?

Ankle Stirrup

What brace/support is used for broken toes?

Orthopedic Shoe

Thermoskin Night splint, Passive Night Splint, and Strassburg Sock are all braces/supports used for what condition?

Plantar fasciitis

What is pain over the metatarsal heads of the foot?

Metatarsalgia

What brace/support should be placed over the shafts of the metatarsal bones to lift them and support the transverse arch of the foot?

Metatarsal pad

What support can help with lower neck pain (not disability) and applies mild traction on the neck?

Cervical Pillow

What brace/support prevents motion and stabilize the cervical spine with slight distraction when there is a fracture, sprain, or instability?

Philadelphia collar

What brace/support is used to remind the patient not to move the neck

Soft cervical collar

How should the wrist be braced in carpal tunnel syndrome?

Neutral position while the patient sleeps

What are the 3 classifications of supports?

1) Soft goods

2) Semi-rigid

3) Rigid

What support/brace facilitates muscle contraction, prevents over-contraction, facilitates lymph flow and treats swelling?

Kinesio Tape

What is the act of rubbing, kneading, or stroking the superficial parts of the body with the hand or with an instrument for the purpose of modifying nutrition, restoring power of movement, or breaking up adhesions?

Massage

What are the 8 indications for Massage?

1) Superficial adhesions

2) Circulatory stasis

3) Congestion

4) Edema

5) Myalgia/Trigger

6) Tension headaches

7) Post-exertion fatigue

8) Stiffness

What type of massage are long stroking motions, either superficial or deep, applied with palm of the hand or flats of the fingers in parallel with the orientation of the muscle fibers?

Effleurage

What type of massage is kneading the muscle tissue by squeezing, pinching, or rolling?

Petrissage

What is rhythmic mechanical rapid blows to the tissue?

Tapotement (Percussion)

What type of Tapotement (Percussion) is:

- with tips of the fingers?

- ulnar border of hand (chopping)?

- with fingers?

- with cupped hands?

Tapping

Hacking

Slapping

Cupping

What is shaking or trembling of underlying tissue in quick back and forth motions perpendicular to the orientation of the targeted muscle fibers, and is applied form distal to proximal?

Manual Vibration

What is deep, rapid, short duration percussion using a mechanical device?

Mechanical Vibration

What vibration frequency has effects such as analgesia, decrease trigger points, pre-exercise warm-up, relaxes spasticity, and superficial circulatory stimulation?

High Frequency

What vibration frequency has effects similar to high frequency (analgesia, decrease trigger points, pre-exercise warm-up, relaxes spasticity, and superficial circulatory stimulation) but milder?

Medium Frequency

What vibration frequency has effects such as a decrease congestion, decrease edema, decrease stasis, milk tissue, or postural drainage?

Low Frequency

What type of massage places tissue on a slight stretch with massage directly over lesion or pain, perpendicular to orientation of tissue fibers, the fingers stay in contact with no lotion, sweeping the full width of tissue? How long should this be done for?

Cross-Tissue Massage

Time = 7-10 minutes or until numb

What is a focus of hyperirritability in muscle or fascia which produces local and referred pain?

Trigger Point

What tissue change around trigger points is a tight band of fibers which can be "snapped" like a rope, causing hyper-excitability in surrounding musculature (known as a twitch response)?

Rope Sign

How are trigger points treated in Nimmo technique?

Ischemic compression

What is an additional way that Travell treats trigger points?

Spray & stretch using vapocoolant spray

What are two methods of myofascial release?

1) Active Release Technique (ART)

2) Pin & Stretch

What is the using of instruments, commonly metal instruments, to allow deep soft tissue mobilization, loosening adhesions and scar tissue?

Instrument Assisted Soft Tissue Mobilization (IASTM)

What are two common IASTM techniques in chiropractic?

1) FAKTR-PM

2) Graston Technique

What is drawing or pulling apart of a body segment?

Traction

What are the 4 methods of traction?

1) Manual

2) Positional

3) Mechanical

4) Inversion

What are the 4 indications for spinal traction?

1) Disc herniations

2) Nerve Root impingement

3) Joint hypomobility

4) Arthritis

Is static or intermittent traction preferred?

Intermittent is more tolerable

How much tension should be applied for cervical traction?

10-30% body weight

How much tension should be applied for lumbar traction?

30-60%

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

Pain

What are the 5 stages of response to terminal illness as described by Kubler and Ross?

1) Denial

2) Anger

3) Bargaining

4) Depression

5) Acceptance

Does Kubler-Ross model work for injured athletes?

NO

- although it often described for injures

Should use Cognitive Appraisal model

What model states that response to injury depends on understanding of the injury, with knowledge being power?

Cognitive Appraisal Model

What are 4 purposes of pain?

1) Warns of impending injury

2) Essential for survival

3) Signifies something wrong

4) Limits further injury

What are the goals of reducing pain? (2)

1) Facilitate return to normal movement & function

2) Limit adaptive changes that may contribute to subluxation and hinder long term subluxation correction

What is the pathway for transmission of pain? (3)

Transduction of a peripheral nociceptive fiber

1st order afferent synapses with 2nd order at the spinal cord

2nd order afferent synapses on 3rd order neuron at thalamus

Which nuclei of the thalamus receives pain signals with ascending pain fibers from the body? Which receives pain signals with pain fibers form the head and face?

VPL (ventral posterior lateral)

VPM (ventral posterior medial)

What are 2 categories of pain modulation?

Peripheral & Central pain modulation

What are 2 methods of pain modulation?

1) Local pain modulation such as ice

2) Pain gating by activating A-beta fibers

What are 2 methods of central pain modulation?

1) Motor pain modulation (motor TENS and IF for chronic pain)

2) Noxious pain modulation (Noxious TENS and ice)

What is high intensity exercise or activity that causes increased endogenous opioid production, meaning pain may not be felt at a high level at first when an athlete is injured?

Exercise induced hypoalgesia

What are the 3 components of neuromuscular control?

1) Consciously controlled muscle contraction

2) Reflex responses

3) Complex movement patterns

What is meant by conscious muscle contraction?

Muscle contraction should be quick and efficient

What happens to conscious muscle contraction after injury?

Muscles become inhibited and contraction is slow and diminished

What are muscle reflexes that are protective, for example, contraction of the lateral lower leg muscles to prevent inversion injuries of the ankle?

Reflex responses

What happens to reflex responses following injuries?

The protective reflexes stop working due to damage to the peripheral nerves

What is activation of neurons in the brain to accomplish tasks without thinking about it, like your brain is running an app for the activity?

Complex movement patterns

What 3 things lead to loss of neuromuscular control?

1) Pain

2) Swelling

3) Altered afferent input

What is the use of information to bring physiological events to conscious awareness in the patient?

Biofeedback

What is biofeedback used for?

1) Stress management

2) Teaching aid for muscle retraining

What are 5 examples of methods for biofeedback?

1) Clinician

2) Mirror

3) Video recording

4) Patient

5) Electromyography

What are questionnaire measures designed to quantify the subjective complaints of a patient, used to document progress of your patients beginning with the departure from wellness and subsequent progress?

Outcome measures