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76 Cards in this Set

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Spinoparabrachial Tract consists of:
the affective component of pain
Spinoreticular Tract consists of:
1. Modulation of pain
2. Motivational, emotional, unpleasant component of pain
Spinohypothalamic-Limbic Tract consists of:
Autonomic adjustments to pain
Anterolateral Systems "Take Home" message is that is has:
1. Multiple ascending pathways
2. Ipsilateral, contralateral, bilateral
3. Redundant system
Names the Different States of pain:
1. Acute Pain
2. Referred Pain
3. Persistent Pain
Acute Pain is:
Rapid onset
Short duration (usually)
Warning of tissue damage (actual or potential)

**A Delta is most responsible for this**
Referred Pain is:
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

Ex. Heart Attack
Persistent Pain is:
Pain that is recurrent or episodic

May accompany a re-injury or associated chronic condition

Ex. Someone with poor posture can cause neck pain (It comes and goes)
You can assess pain by:
1. Numerical
2. Verbal rating scale
3. Visual analog scale
Assessment Scales should include:
Observation of non verbal cues
Mode, duration of onset
Provocating and relieving factors

**look for non-verbal cues
Numerical Pain Scale Is:
Give pt 0 to 10
Qualify numbers
What is zero, what is ten
Verbal Rating Scale is:
No pain, mild, moderate, etc.
Visual Analog Scale is:
Number line, or Faces for Kids!
Abnormal Pain can be:
1. Allodynia
2. Hyperalgesia
3. Neuropathic
4. Chronic Pain
Parallel Ascending Pathways of Pain are from
spinal cord to higher centers
Parallel Ascending Pathways of Pain have Multiple Pathways and they are what?
Spinothalamic Tract, Spinomesencephalic tract, Spinoparabrachial tract, Spinoreticular tract, Spinohyphothalamic-limbic tract
Parallel Ascending Pathways of Pain are also known as:
Anterolateral System
Spinothalamic Tract has what actions involving in it:
Discrimitive pain
Crude touch
Spinomesencephalic Track has:
Pain modulation
Sensorimotor integration of pain
Motor reflex to pain
What does Ipsilateral, Contralateral, and Bilateral mean:
Ipsilateral-SAME SIDE
Bilateral- Both side at the same time!!!
Pain States Consist of:
Pain sensation increases when painful stimulus persists

This can lead to pathologic pain states, where pain persists without the initial trauma.
How many points on a Scale can you move up and down to see a difference in someone pain level?
If pain decreases by 2, you are making a difference in their pain for the better

Increase by 2 (makes it worse), It is important to access it each visit when you see them
Cold Modalities are:
One of the most effective and least expensive modes of acute injury and pain management
What 3 things does cryotherapy cause the body to do?
Decreased swelling, vasoconstriction,
Decrease muscle spasm so should have more ROM
Decrease pain
In Cryotherapy, you want to _______ blood flow and metabolism __________ bleeding and inflammation (acute swelling)

Decrease; Decreased
In Cryotherapy, you want to ________ in muscle spasm allows for _________ pain free ROM

Decrease; Increase
Does pain threshold increase or decrease?
Conduction is:
transfer of energy through direct contact
Convection is:
what would occur if you had them in a cold whirlpool

In something moving around; Gravity depended position will cause more swelling
Evaporation is:

The cooler substance pulls the heat out, then evaporates off the skin.

**Cooler substance cooling it off like Cooling spray
In Cryotherapy, cooling is accomplished by:
removing heat from an object

**Actually removing the heat not adding cold
Thermal conductivity is the:
Efficiency of a material or tissue to conduct heat

**Metals more efficient than non-metals
Conduction transfer of heat by:
Direct interaction of the molecules in the warmer area with those in the cooler area

Ex. Ice packs, cold water immersion, ice water filled cuffs
Tissues with higher water content have better thermal conductivity like:
Muscles better than adipose tissue

Adipose (fat) tissue serves as an insulator and resists heat transfer (gains or losses)

Muscles generally sit under adipose tissue
With application of cold therapies the patients will experience 4 different stages, what are they?
1. Cold
2. Burn
3. Ache
4. Numbness

Ex. Ice Massage

**Make sure you explain to your patients what is going to happen!!
Factors Influencing Cold Therapy Response are:
1. Temperature difference between cold object and soft tissue
2. Time of exposure
3. Thermal conductivity
4. Type and size of cooling agent
5. Body surface to be covered
6. Activity level
7. Ability of cooling agent to maintain its temperature
Arterial blood is warmer than venous and with _______ blood flow you get ________ arterial blood

Decrease; Decreased
The energy transfer between arteries and veins increase/decrease?

**Arteries and veins are close to each other
Convection is:
Direct connection between skin and moving fluid

Rarely used because machines are expensive, bulky, big

Ex. Cold whirlpool, Specific heat of water
Convection is not encouraged in the Acute Phase of Healing, Why?
Because you DO NOT want to put heat on an ankle sprain right away, puts the extremity in a dependent position- increase EDEMA!!!
Heat loss in Convection is:
25 x greater in water versus air

**Heat abstraction occurs a lot faster than cold
Vapocoolant Spray is:
1. Used for pain relief for trigger points before stretch

**Volatile liquids, Evaporates immediately, Upon contact with skin it extracts heat
Vapocoolant is applied in:
sweeping strokes

**Temp can drop by 15 degrees C
Hemodynamic Effects of Cold Agents are:
1. Immediate response is vasoconstriction of cutaneous blood vessels
2. Vessel diameter most significant factor relating to blood flow
3. Exposure to cold therapy for 15 minutes or less
4. Vasoconstriction of arterioles and venules
5. Posttraumatic Edema and Inflammation
6. First 24-72 hours cold is usually the modality of choice
Peripheral Nerve Effects are:
1. Cold alters conduction velocities
2. May also cause failure to conduct impulses

**Cooling to 56° F blocked conduction of A fibers, Lower than 56 to block C fibers

Some cases of neurapraxia and axonotmesis
Neuropraxia is:
Failure of nerve conduction blocked without structural damage – 1hr of ice
Temporary condition, effects usually reversed in 6-8 weeks
Least serious
Axonotmesis is:
discontinuity of axons, but endo, peri,
Epineurium Intact you should:
Ice for 2hrs
More severe than neuropraxia
Long lasting & more dangerous
What are the effects of Cryotherapy on the muscle?
1. Debate is whether to ice before or after
2. Increase in strength after 5 minutes of ice massage
3. Decrease in strength after 30 minutes of immersion in 10 to 12 degrees C (Possibly due to decreased muscle blood flow, Strength then increased)
Neuromuscular Effects can:
help reduce spasticity

**Seen with increased DTR and with clonus; Effects temporary
Primary Goals of Cryotherapy are to:
Limit edema
Reduce pain
Muscle relaxation/ contraction
Limit secondary hypoxic tissue injury
What does RICE or PRICE mean?
Cryokinetics, you should:
should be apply cold for a maximum of twenty minutes to numb the area

Process can be repeated for 5 minutes to 're-numb' the area if necessary

Exercises performed during cryokinetics are active & should be gradually increased in intensity providing they remain pain free
Myofascial Pain is:
referred from active myofascial trigger points with associated dysfunction

Trigger points present in skin, ligaments, and fascia

May be related to muscle strain
Trigger points found via digital pressure

Ex. Stretch & spray, ice massage, deep pressure
In Cryotherapy, Spasticity goal is to:
1. Decrease tone to allow for increased movement
2. Cold applied over the hypertonic muscle for 10 to 30 minutes
3. Various methods used
4. Effects last approx 1 to 1.5 hrs
You want to use cold for how long for spasticity:
10-30 minutes

**Low load, long duration stretch is best for spasticity; Don’t want to excite the muscle spindle
Guidelines for Use, you need to be:
1. Familiar w/ medical history & status like Contraindications
2. Time post injury
3. Consider safety Ex. Try small region first; Avoid potential stresses of tissue for approximately 2 hours
Cold Packs are? and How do you use them?
Inexpensively purchased or easily made

1. For hygiene, use layer of towel
2. Be careful with chemical ice packs (packs that must be popped), as the chemicals can burn skin if exposed.
3. Gel packs typically stay cool for 15 to 20 minutes
Ice Massage is?
Typically done over small region

Ex. Muscle belly, tendon, bursa, trigger points
Typically done over small region

Ex. Muscle belly, tendon, bursa, trigger points
How do you do Ice Massage:
1. Freeze water in paper or foam cup or use commercially available ice massage cups
2. A 10 by 15 cm region may be covered in 5 to 10 minutes
3. Use small overlapping circles
During Ice Massage there are 4 sensations that should happen (Intense Cold, Burning, Aching, Numbness CBAN) and the Burning and Aching should pass in approx., how many minutes?
1-2 minutes
Cold Baths are:
Used to cool distal extremities
Water temps range from 13 to 18 degrees C
Lower temps correlate with shorter immersion times
Basin of cold water and ice is sufficient
Vapocoolant Spray you want to:
1. Position patient to facilitate relaxation
2. Muscle is put on passive stretch
3. Spray in unidirectional motion
4. Over trigger point
5. Over referred pain regions
1. Position patient to facilitate relaxation
2. Muscle is put on passive stretch
3. Spray in unidirectional motion
4. Over trigger point
5. Over referred pain regions
Cold Gels are:
Creams that give perceived sensation of cold
Easy to apply
Very portable
No need for refrigeration

Ex. BioFreeze
Creams that give perceived sensation of cold
Easy to apply
Very portable
No need for refrigeration

Ex. BioFreeze
Polar Packs/Game Ready are for:
Acute musculoskeletal injuries
Status post surgery
Range from 10 to 25 deg C
Intermittently inflated to push edema out of region
Acute musculoskeletal injuries
Status post surgery
Range from 10 to 25 deg C
Intermittently inflated to push edema out of region
Contraindications for Cryotherapy are:
Cold Intolerance
Raynaud’s Disease
Over a regenerating peripheral nerve
Over an area of circulatory compromise
Over an area of peripheral vascular disease
pt. has allergic reaction to cold (hives)
Cold Tolerance:
pt. doesn’t like the cold
Cryoglobulinemia is:
abnormal blood protein forms gels when exposed to cold. Can lead to ischemia or gangrene

**Patient should know this prior to therapy
Raynaud's Disease is:
Vasospastic disorder, cooler than 60 degrees. Shunting blood away

**Over a regenerating peripheral nerve – you want it to regenerate
Precautions for Cryotherapy are:
Over a superficial peripheral nerve (danger of neuropraxia)
Over an open wound
Poor sensation (can't feel how bad it can hurt)
Poor cognition (doesn't understand you)
Very young or very old (typically like heat)
Aversion to cold (doesn't care for cold)
How do you know Cryotherapy is working?
ROM increased
Decrease swelling
Perceived pain (how well it feels)
Girth measurement
What are the Parameters you need to document when giving cryotherapy?
Type of agent
Time on it
Use anything to help compress it
Skin color after
How they are seating/laying
You should always be aware of the changes in the patients response by:
1. Beneficial or adverse
2. Skin color
Case Study # 1

A 17 year old male is referred with a diagnosis of acute grade II right lateral ankle sprain that occurred 12 hours prior. After the examination he demonstrated notable effusion throughout the right ankle, (lateral>medial) decreased AROM, and pain that increases with AROM or PROM and while WB.

1. Does the pt. have a dysfunction, limitation, or problem that can be improved with the use of cryotherapy?

2. What type of cryotherapy could be used and what specific parameters are appropriate?
1.Yes, pain can be reduced allowing more ROM, resistive exercise and increase WB to complete normal gait cycle, swelling can be reduced.

2. Until numbness to the area is felt, icepack, ice bath,
Case Study #2
Look at in the Powerpoint (last slide in Cryotherapy)