KINE 55023 Midterm Exam - Study Outline.docx

Midterm Exam -- Study Outline Ch. 1: Therapeutic Modalities - Purposes/therapeutic goals of modality use - Promote and improve - Wound healing - Pain relief - Flexibility and ROM - Muscular strength - Muscular speed - Muscu...

Midterm Exam -- Study Outline Ch. 1: Therapeutic Modalities - Purposes/therapeutic goals of modality use - Promote and improve - Wound healing - Pain relief - Flexibility and ROM - Muscular strength - Muscular speed - Muscular coordination - Muscular power - Agility - Cardiorespiratory endurance - The art and science of modality use (4 sources) - Tradition - Experience - Science - Theory - Modality selection criteria - Thorough eval resulting in a correct diagnosis - Understanding the pathologic and physiologic changes associated with injury - Treatment plan outlining therapeutic goals - Understanding of modalities effects, indication, contraindications Ch. 2: Evidence Based Practice - What is EBM? EBP? - Evidence based medicine (EBM) - Medicine based on the latest and most rigorous scientific evidence, integrates with clinical experience and patient preferences. - Evidence based practice (EBP) - Application of the principles of EBM to professional practice - Outcome measure types + examples - Clinician or disease-oriented outcomes - Physiological data and measures made by a clinician during the evaluation process - Examples: Xray results, ROM measurements - Patient oriented outcomes - Patients' assessment of their current health status, level of function, symptoms, health care cost, and quality of life. - Examples: quality of wellbeing, short form 12 health survey, hip disability and osteoarthritis outcome score, foot and ankle outcome score. - Levels of evidence A diagram of a scientific research Description automatically generated - Best practices - Specific treatment plan to resolve a patient's condition in the most complete way - Standard of Care - Another name for best practices - Clinical Practice Guidelines - Systemically developed statements that describe the best and achievable practice for a specific area of care Ch. 3: General Application Procedures - Cookbook vs critical thinking approach - Cookbook - Following a protocol for each injury disregarding the patient's genetic makeup, health history, preinjury state, work ethic, severity of injury, rate of progress, and time of season. - Critical thinking approach - Organized procedural outline with broad guidelines - Empowers the clinician - Standard operating procedures - Specific guidelines and protocols for performing a specific task - Form of quality control - For complex tasks promotes consistency - Potential disadvantages - Promotes cookbook approach - Daunting to learn - 5-step application framework & subcomponents - Foundation: description, effects, advantages, disadvantages, indications, contraindications, precautions - Definition - A description of the modality and the basics of how it operates - Effects - The physiological/pathologic changes the modality evokes locally and systemically - Advantages - The benefits of the modality that make it more effective in treating injuries than other modalities - Disadvantages - The possible negative effects the modality might cause as well as the benefits that might be lost from not using this modality - Indications - Situations in which the modality should be used or for which it is a suitable treatment - Contraindications - Situations in which the modality should not be used - Precautions - Situations that could cause harm if the clinician is not careful - Pre-application - Select the proper modality - Determine the pathologic/physiological changes associated with the injury - Establish the therapeutic goals - Match the goal with a modality that would help achieve the goal - Make sure the modality is not contraindicated - Prepare the patient psychologically - Explain the purpose and expected outcome - Prep the patient physically - Remove clothing, bandages, or braces as necessary - Position the patient comfortably - Equipment prep - Set up equipment - Do a safety check - Application - Procedures - Turn on unit - Adjust the parameters - Dosage - Time - Frequency - Duration (days, weeks) - Post-application - Equipment removal/cleanup - Patient cleanup - Record the treatments - Instruct on what they should do between visits - Maintenance - Routine maintenance - Repairs Ch. 4: Injury Record Keeping - Purpose of record keeping - Communication and quality control - Legal protection - Research - History - Traffic patterns - Types of SOAP notes - Initial note - Written after the initial assessment - Progress note - Periodic documentation of the results of the treatment plan - Discharge note - Written when treatment is discontinued - Initialing and dating - Always date initial your notes - Initials tell the clinician whom to go to for additional info - Date establishes when the entry was created Ch. 5: Tissue Response to Injury - Cardinal signs of inflammation - Rubor-redness - Calor- heat - Edema- swelling - Dolor- pain - Funca laesa -- functional loss - Sequential events of inflammatory process - Injury - Ultrastructural changes - Chemical changes - Hemodynamic changes - Metabolic changes - Permeability changes - Leukocyte migration - Phagocytosis - Macro- vs microtrauma - Macrotrauma - Caused by a large insult and results in immediate tissue disruption. Acute injuries - Microtrauma - Is caused by small or low-grade stress that wears away the tissue over time. Chronic injuries or overuse. - Neutrophils vs macrophages - Neutrophils - Smaller, faster, and more numerous than macrophages. They arrive at the injury site first and are a temporary first line of defense against bacterial infections. - Macrophages - Live for months and can reproduce. Provide a long lasting second line of defense. Main function is cleaning up the cellular debris to prep for repair. - Recurring vs chronic inflammation - Recurring inflammation - Reinitiated acute inflammation before the previous episode of acute inflammation has finished. - Chronic inflammation - Begins in a slow unnoticed manner. Occurs when the inflammatory response can't eliminate the cause of injury. - Primary vs secondary injury - Primary injury - Direct result of the initial physical forces - Secondary injury - The body's response to the traumatized tissue. - Secondary enzymatic - When a cell dies, due to primary injury, its lysosomes release enzymes to digest cellular debris. - Secondary metabolic - Caused by prolonged local ischemia - A deficit of blood to the area - Edema vs swelling vs inflammation - Inflammation - The local response of the body to an injury - Edema - Is the accumulation of the fluid portion of blood in the tissues - Swelling - Increase in tissue volume owing to extra fluid and cellular material in the tissue. - Two sources - Hemorrhage - Edema Ch. 6: Immediate Care of Orthopedic Injury - RICES - Is applied to protect the injury from further damage and to decrease of minimize development of swelling, pain, muscle spasm, neural inhibition, secondary injury - Rest - Ice - Compression - Elevation - Stabilization - Immediate care vs acute care - Acute care - 0-4 days - Immediate care - 7-12 hours - Why cryotherapy as immediate care? - Decreased blood flow theory - Decreased secondary injury theory Ch. 7: The Healing Process - Phases of repair (& what occurs in each) - Hemostasis and inflammation - Lymphatic drainage - Epithelialization - Developing a membranous tissue covering exposed tissue (epithelium) - Proliferation - Angiogenesis - Growth of new blood - 4-6 days - Collagen synthesis - Manufacturing and laying down collagen in the wound space - 6-20 days - Collagen strands realign parallel to the lines of force - Wound contraction - Pulls the sides of the wound together attempting to close - Remodeling - Contraction - Collapse of capillary arcade - Restructuring - Collagen itself is reconstructed to parallel arrangement - Healing modifiers - Heling process may be facilitated or hindered in many ways - Immediate care procedures - Pain - Wound closure - Exercise - Modalities - Therapeutic goals x modality examples - Stimulate healing process - Ultrasound - E-stim - Hot packs - Promote lymphatic drainage - Massage - Cryokinetics - Edema pressure devices - Moderate pain - Cryokinetics - Cryostretch - TENS Ch. 8-9: Understanding & Relieving Pain - Anatomy review related to pain - Hypothalamus - Control station for the body's activities - Thalamus - Sensations such as heat, cold, pain, touch - Cerebral cortex - Intensity and location of pain - White and grey matter (ADam and EVe) - Afferent nerves - Arrive at dorsal horn - Efferent nerves - Exit at ventral horns - Pain perception modifiers - Heredity - Psychosocial experience - Prior pain experience - General life stress - Pain pathway - Noxious stimuli travel to the spinal cord entering through the dorsal horn. Then exits at the ventral horn into the thalamus then to the cerebral cortex. - Pain theories: - Specificity - Occurs when specific nociceptive receptors in the periphery are stimulated - Sends impulse on specific neural pathways - Doesn't explain - Phantom limb - Why people react differently - Pattern - Denies the existence of specific pain receptors - Pain occurs when it reaches a certain threshold - Doesn't explain - Slow conducting nerve fiber carry pain - Fast acting nerve fibers carry other sensations - Gate control - Operates at spinal level - Proposes gate mechanism - Located in the dorsal horn - Only one sensation at a time - Neuromatrix - Pain is a multidimensional experience - Unique to each person - Fear Avoidance - Proposed to explain why acute back pain turns into chronic - Origins of orthopedic pain - Nociceptive - Response to injury to the body - Neuropathic - Complex, chronic pain, usually tissue damage - Idiopathic - Unknow origin - Learned - Developed from a patient's pain memories - Placebo/placebo effect - A placebo is a medically inactive substance that appears as the real thing. - Placebo effect - Measurable, observable, or felt improvement in health not attributable to treatment