Modalities: Concepts Of Healing/pain/sensation Testing (1A)

Front 1

Lymphocytes include:

Back 1

Include T and B-lymphocytes

Also NK cells

Front 2

Lymphocytes in Chronic inflammation:

Back 2

Arrive approximately 5 days post injury
Prominent in chronic inflammation
Essential 4 normal tissue repair
Enhance macrophage function

Front 3

Lymphocytes can be associated with:

Back 3

repetitive microtrauma, autoimmune responses, chronic conditions

**Does not have the cardinal signs of inflammation

Front 4

Histamine:

Back 4

vasodilation, exudate formation, itching, capillary premablity

Front 5

Kinin (Bradykinin Etc.)

Back 5

vasodilate, form pain, exudate formation

Front 6

Prostaglandin:

Back 6

sensitize blood vessels to inflammatory mediators and nocirecptors

Front 7

Complement:

Back 7

Kills cell lyosis, non-specific, and specific , enhances defense

Front 8

The Four Components of Repair Phase are:

Back 8

1. Granulation
2. Fibroplasia
3. Angiogenesis
4. Re-epithelialization

Front 9

Granulation present indicates:

Back 9

"normal" healing

**Named for its cobbled appearance**

Front 10

Fibroplasia are:

Back 10

Fibroblasts drawn to wound from dermis by cytokines

Fibroblasts then change into myofibroblasts

As new blood vessels are produced myofibroblast production slows

Front 11

Angiogenesis occurs by:

Back 11

1. Sprouting of new pathway
2. Anastomosis with new and existing vascular paths

A response to:
Hypoxic environment
Free edge effect
Cytokines: platelets etc.

Front 12

Re-epithlization is important for:

Back 12

providing barriers to infection and to decrease fluid loss

**Concurrent with the formation of granulation tissue

Front 13

Fibroplasia have:

Back 13

Collagen (Type III) present in wound as soon as 2 days!!

Front 14

Ground substance is:

Back 14

Gelled material that forms the extracellular matrix &
Facilitates fibroblast production & absorbs large amounts of water

**ADDS FLEXIBILITY**

Front 15

Angiogenesis is a response to:

Back 15

1. Hypoxic environment
2. Free edge effect (wound is present)
3. Cytokines: platelets etc.

Front 16

Cellular Production is:

Back 16

Contact inhibition is mediated by cytokines known as chalones

**NEED TO HAVE FREE EDGE EFFECT TO KNOW IT NEEDS TO OCCUR**

Front 17

Migration is the:

Back 17

Process of cell movement from periphery to center &
occurs over granulation tissue

Front 18

3 stages of remodeling phase is:

Back 18

1. Collagen conversion
2. Wound contraction
3. Scar formation

Front 19

Remodeling Phase is the:

Back 19

Balance between tissue synthesis & degradation

**want both to occur

Front 20

Key Point to Collagen Conversion is that:

Back 20

Oxygen is necessary for collagen cross-linking to occur

Front 21

Wound Contraction is:

Back 21

Process that closes wound after tissue loss
*Myofibroblasts connect with fibronectin
which then connect with collagen fibers

Actin in the cytoplasm draws the collagen closer together

Front 22

Wound Contraction results in:

Back 22

faster healing since it decreases the amount of tissue that must be repaired & remodeled

Contraction decreases the size of full-thickness wounds by 40% & is associated with concurrent scarring

Front 23

Scar Formation has four stages, what are they?

Back 23

Stage 1-4

Front 24

Stage 1 of scar formation is:

Back 24

2-4 days post injury
Type III collagen
Prone to tear

Front 25

Stage 2 of scar formation is:

Back 25

5-21 days post injury
Type III converted to type I collagen
Less likely to tear
Most receptive to intervention

Front 26

Stage 3 of scar formation is:

Back 26

21-60 days post injury
More fibrous and strong
Decreased response to intervention

Front 27

Stage 4 of scar formation is:

Back 27

60 days on post injury
Scar maturation
Final appearance
Unresponsive to treatment, surgical intervention considered

Front 28

What kind of scar is this?

Back 28

Hypertrophic scar

Front 29

What kind of scar is this?

Back 29

Keloid Scar

Front 30

Keloid scars are:

Back 30

Typically extend outside of wound bed

Seen typically in Asian and African populations

Front 31

Hypertrophic scars:

Back 31

Do not extend outside of wound bed

Front 32

Type III is gradually lysed by collagenase and converted to Type I in what length of time:

Back 32

300 days

**The stimulus for this conversion is stress and strain
Ex. Tension, compression

Front 33

In collagen conversion, Type III converted to:

Back 33

Type I

Front 34

Type III is synthesized during the first:

Back 34

48-72 hours

Front 35

Collagen Conversion tissue breaks strength to pre wound values by:

Back 35

20% by third week prior to being damaged

70-80% in several months down the road

Front 36

Pain is defined as:

Back 36

Unpleasant sensation
Unpleasant emotional response
Actual or potential tissue damage
Warning signal so appropriate response evoked

Front 37

What is pain perception?

Back 37

Establish cognitive value & response priority

Based off of experience & involves sensory, emotional, motor, and cultural components

Front 38

Pain usually helps with:

Back 38

tissue healing by preventing us from further aggravating our pathological and painful conditions.

Front 39

What are the two sources of pain?

Back 39

1. Peripheral Nociceptive
2. Peripheral Neurogenic

Front 40

Peripheral Nociceptive pain is:

Back 40

Pain transmitted via A delta and C fibers to dorsal horn & to brain

**Its a sharp, acute pain that is localized to that injured tissue

Front 41

Peripheral Neurogenic Pain is:

Back 41

Creates abnormal impulse generator sites (AIGS)

Nerve can be stripped of myelin

**Its an Injury to the nervous system

Front 42

Central Pain source creates:

Back 42

abnormal pain states

Front 43

Allodynia is:

Back 43

pain provoked by stimulus that doesn’t normally cause pain

Ex. Someone brushing up against you

Front 44

Hyperalgesia is:

Back 44

heightened response to a painful stimulus, should hurt but "reaction" is GREATER than you would expect

Front 45

Chronic Pain is:

Back 45

1. Pain that last longer than 6 months
2. People sleep less (can’t sleep) & truly depressed
3. It never truly goes away, too much damage was done
4. Pain can “go away” but comes back

**Physical therapy can helpmanage pain & symptoms

Front 46

Neuroanatomy

Back 46

GET FROM MELISSA DONT HAVE IN NOTES!! :(

Front 47

What are the 3 Afferent Types?

Back 47

1. Interoceptors
2. Exteroceptors
3. Proprioceptors

Front 48

Interoceptors are:

Back 48

Found within the system
Monitor blood pressure internally
Blood o2 levels

Front 49

Exteroceptors are:

Back 49

anything that responds outside the body

Ex. Eyes, Ears, Mouth, Etc.

Front 50

Proprioceptors can be:

Back 50

a mixture of both Interoceptors & Exteroceptors

Front 51

A Delta Fibers are:

Back 51

1.Primarily mechanical nociceptors which are Sensitive to pressures intense enough to cause damage
2. Sensation is sharp, pricking & last 4 a short duration
3. Localized & tolerated well

Front 52

C Fibers make up:

Back 52

1.Majority of nociceptors
2.Sensitive to very intense mechanical & temperature

**Some are Specific to chemical (acid, irritants, inflammatory mediators) or mechanical pressure only

Front 53

Non-Nociceptive Afferents are mechanoreceptors which include:

Back 53

1. Meissner’s corpuscles
2. Pacinian corpuscles
3. Merkel’s discs
4. Ruffini ending

**Should not cause pain!

Front 54

Meissner's Corpuscles are:

Back 54

very sensitive to light touch

**Found most places on the body

Front 55

Pacinian Corpuscles are:

Back 55

found to be more adapt to changes in pressure & vibration

**Juries still out if research can tell the difference between smooth and rough

Front 56

Merkel discs tend to:

Back 56

pressure and texture

Ex. Smooth and Rough

Front 57

Ruffini Endings have:

Back 57

1. No adaptation in general (Alot Deeper)
2. SUSTAINED PRESSURE
3. Deals with mechanical deformation of joints
*Can act as thermoreceptors (DEEP BURN,not good)

Front 58

Proprioceptors in Non-Nociceptive Afferents exist in:

Back 58

Joint capsules, Muscles & Tendons

Ex. Ruffini endings, Muscle spindles & Golgi tendon organs

Front 59

Thermoreceptors in Non-Nociceptive Afferents sense:

Back 59

Change in temperature in the skin, Joint capsules and Ligaments

Ex. Krause’s end bulb & Ruffini

Front 60

Krause's End Bulb is:

Back 60

more adapt to cold temperature than hot temperature

Front 61

Thermal Nociceptors deal with:

Back 61

1. Both A delta and C fibers
2. Some are sensitive to changes that barely vary from the norm (depending the severity of the burn)
3. Others require extreme temps to fire

Front 62

Some A Delta and C Fibers respond to __________, in the interoceptors category:

Back 62

1. Molecules of local metabolism
2. Mast cell activation
3. Hormonal activity

Front 63

Homeostatic Receptors have:

Back 63

Low threshold A delta fibers & can send signals of weak mechanical stimuli

**It Evoke feelings of sensory touch &Emotional response comes into play (Ex. Pleasure Memory)

Front 64

Chemical Nociception is:

Back 64

1. Tissue trauma causes a release of multiple chemicals from the damaged cells
2. These elicit a response from nociceptors to release various neuropeptides
3. Then Enhances the sensation of pain

Front 65

Name the Different Levels of Dermatones:

Back 65

???? GET FROM LAB PAPERS!!!

Front 66

Parallel Ascending Pathways of Pain goes from:

Back 66

From spinal cord to higher centers & have mult. pathways.

Front 67

The most important pathway of the Parallel Ascending Pathways of Pain is:

Back 67

**Spinothalamic Tract**

Other Tracts:
Spinomesencephalic , Spinoparabrachial, Spinoreticular, Spinohyphothalamic-limbic

Front 68

All the Parallel Ascending Pathways of Pain make up what system?

Back 68

Anterolateral System

Front 69

Spinothalamic Tract consists of:

Back 69

1. Discrimitive pain
2. Temperature
3. Crude touch
4. Pressure


**STOPPED HERE FOR QUIZ THURSDAY!!!**

Front 70

Spinomesencephalis Tract consists of:

Back 70

1. Pain modulation
2. Sensorimotor integration of pain
3. Motor reflex to pain

Front 71

Spinoparabrachial Tract consists of:

Back 71

the affective component of pain

Front 72

Spinoreticular Tract consists of:

Back 72

1. Modulation of pain
2. Motivational, emotional, unpleasant component of pain

Front 73

Spinohypothalamic-Limbic Tract consists of:

Back 73

Autonomic adjustments to pain

Front 74

Anterolateral Systems "Take Home" message is that is has:

Back 74

1. Multiple ascending pathways
2. Ipsilateral, contralateral, bilateral
3. Redundant system

Front 75

Names the Different States of pain:

Back 75

1. Acute Pain
2. Referred Pain
3. Persistent Pain

Front 76

Acute Pain is:

Back 76

Sharp
Localized
Rapid onset
Short duration (usually)
Warning of tissue damage (actual or potential)

Front 77

Referred Pain is:

Back 77

Pain at a site remote from the source of pathology & occurs due to convergence

Brain unable to decipher or determine where pain is coming from

Front 78

Persistent Pain is:

Back 78

Pain that is recurrent or episodic

May accompany a re-injury or associated chronic condition

Front 79

You can assess pain by:

Back 79

1. Numerical
2. Verbal rating scale
3. Visual analog scale

Front 80

Assessment Scales should include:

Back 80

Severity
Location
Quality
Observation of non verbal cues
Mode, duration of onset
Provocating and relieving factors

Front 81

Numerical Pain Scale Is:

Back 81

Give pt 0 to 10
Qualify numbers
What is zero, what is ten

Front 82

Verbal Rating Scale is:

Back 82

No pain, mild, moderate, etc.

Front 83

Visual Analog Scale is:

Back 83

Number line, or Faces for Kids!

Front 84

Abnormal Pain can be:

Back 84

1. Allodynia
2. Hyperalgesia
3. Neuropathic
4. Chronic Pain

Front 85

C Fibers temperatures ranges are from:

Back 85

< 59 deg F > 123 deg F

Front 86

How large are A Delta and C Fibers?

Back 86

Aδ: Diameter = 1-5 µm; velocity = 2-30 m/sec

C: Diameter = 0.2-1.5 µm; velocity = no more than 2 m/sec

Front 87

C Fibers are:

Back 87

1. Unmylinated & free nerve endings (STRONGER intensity with the stimuli)
2. Stronger Intensity, slow deeper pain &unspecificed area
3. Associated with Chronic Pain
4. Are second to A delta fibers
5. Kick in after a “MONTH”

Front 88

A Delta is:

Back 88

1. Faster than C Fibers
2. Very Fast Onset of Action
3. Mylinated
4. Tolerated Pretty Well

Ex. Touching a Hot Stove

Front 89

Dorsal Horn (Dorsal Root Ganglion-DRG) afferents enter:

Back 89

The spine via the dorsal portion of the spinal nerve

Two point discrimination & proprioception enter through the medial portion of the dorsal root

Nociception (Pain) enters the lateral portion of the dorsal root

Front 90

DRG (Dorsal Root Ganglion) afferent terminates on:

Back 90

The appropriate laminae! They then ascends one to two spinal levels via Lissauer’s tract

Crosses in anterior white commissure

Goes up the spinothalamic tract

Front 91

Nociception means:

Back 91

PAIN!!!

Front 92

7 to 8 Times more likely to go into chronic pain if _________ gets injured?

Back 92

Dorsal Root Ganglion (DRG)

Front 93

DRG (Dorsal Root Ganglion doesn't produce pain for up to:

Back 93

2 - 3 weeks

**This is where Work Comp patients get a bad wrath

Front 94

Examples of Sensory Evaluations are:

Back 94

Touch (light touch, discrimination)
Pain: sharp/dull
Temperature
Vibration

Front 95

Why Do We Need to Assess Sensation?

Back 95

1. Determine areas of sensory loss
2. Following nerve damage (either peripheral or CNS)
3. Before using modalities that could potentially cause harm
4. SAFETY

Front 96

Sensation is:

Back 96

All sensory neuron cell bodies are in the dorsal root ganglia
Considerable overlapping of one area to another
Superficial or Deep

Front 97

The Receptors Activated by Touch are:

Back 97

Free nerve endings (FNE)
Hair follicle receptors
Meisner Corpuscles
Merkel’s Discs
Ruffini Endings
Krause Endbulbs

Front 98

Name all the Dermatone Levels:

Back 98

FINISH

Front 99

When testing Touch on the Sensory Test, you need to:

Back 99

Use piece cotton or tissue
Ask patient to say “yes” each time they are touched- “I want you to tell me when you feel me touch you”
Eyes closed
Soles and palms need heavier stimulus-hairier areas need less stimulation
Test on known innervated area first

Front 100

Tonic Stimulation is:

Back 100

Some sensory receptors respond to tonic activity like Pacinian Corpuscles

Front 101

Nociceptor is:

Back 101

Nerve fiber that fires in response to damaging or potentially damaging stimuli

Front 102

Noxious Stimuli include:

Back 102

Mechanical
Temperature
Chemical
Electric

Front 103

When testing Pain in the Sensory Test, you need to:

Back 103

Use pinprick; unfolded paper clip
Eyes closed
Deliver stimulus in random fashion
Don’t deliver more then 1 stimulus per second
If find decreased sensation, determine boundaries

Front 104

With Temperature, Warm Fibers are:

Back 104

Increase firing with increased temperature
Fire for duration of stimulus
Stop firing when warm stimulus removed
Do not respond to mechanical stimulus

Front 105

With temperature, Cold Fibers are:

Back 105

Increase firing with decreased

Front 106

When do pain receptors begin to fire?

Back 106

Below 20°C and above 45°C

Front 107

When testing Temperature in Sensory Test, what do you need to do?

Back 107

Expose area of skin to be tested
Use 2 test tubes one with hot water, one with cold water
Eyes closed
Randomly apply tubes to body part in question
Ask if feels “less hot or less cold” in comparison to normal side

Front 108

Vibration uses:

Back 108

Pacinian corpuscles and deep afferent nerves

Rarely affected by lesions of single nerves
Involved with polyneuritis & dorsal column disease
Commonly lose vibration & position sense together

Front 109

When testing Vibration in the Sensory Test, you need to:

Back 109

Use tuning fork
Place tuning fork over bony prominence and compare to other side

Front 110

Two-point Discrimination is:

Back 110

Involves sensory cortex and sensory projections from thalamus
Measures the smallest separation between 2 points on the skin that is perceived as 2 stimuli
Use compass or 2 point aesthesiometer

Front 111

When testing Two-Point Discrimination, you need to:

Back 111

Eyes closed
Apply 2 stimuli to skin-ask if feels 1 or 2 points
Varies depending on body location
EX: 2-3 mm lips, 3-5 mm fingertips, 20-30 mm on dorsum of hands and feet, 4-8 cm on trunk

Front 112

Proprioceptors are:

Back 112

Provide information on joint position and muscle tone (Muscle Spindle, Golgi Tendon Organ)

Free Nerve Endings (Pain, Touch)

Pacinian Corpuscle (Deep Pressure)

Front 113

Stereoaugnosis Testing is:

Back 113

Place Familiar Object In Hand and Ask to Identify

Front 114

Tactile Location Testing is:

Back 114

Touch Patient, where the Pressure is Placed

Front 115

Barloaugnosis Testing is:

Back 115

Two Objects - - > One in each hand, different weights of Objects, Ask which object is heavier

Front 116

Graphesthesia Testing:

Back 116

Recognizes Letter Or Design Traced On Skin

Ex. Dram "R" on back or any part of body

Front 117

Texture is:

Back 117

Telling the Difference between:

Smooth Vs. Rough
Silk Vs. Scrubber Pad