Term
| When are indirect techniques useful? |
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Definition
1. trauma
2. Psychological events
3. major pathological events
4. rehabilitation |
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Term
| Indirect technique indications? (8) |
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Definition
|
· symptoms in the sinuses, jaw, face
· congestive states of the neck and head
· trauma
· systemic compression
· chronic conditions
· pregnancy + post pregnancy
· babies and children
· aged patients
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Term
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Definition
An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage”. |
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Term
| In the biomedical view, what does the appreciation of pain require? |
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Definition
activation of peripheral receptors whose signals are conducted along the central nervous system with onward transmission to the higher centres triggering the sensation of pain.
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Term
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Definition
o Transduction, the conversion of injurious energy into neural activity
o 2. Transmission, the relaying of the signals to the brain.
o 3. Central representation, the appreciation of the signals by somatosensory cortex.
o 4. Modulation, attenuation of transmission by descending inhibition.
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Term
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Definition
o In the spinal cord, there are
“nerve gates” (in the dorsal horn)
that can inhibit (close) or facilitate
(open) nerve impulses going from
the body to the brain.
o These nerve gates are influenced by a number of factors including :
§ the diameter of the active
peripheral fibres converging in the dorsal horns
§ “instructions” coming down from the brain.
o Amount of recognition of pain is modulated via which fibres are excited, depending on the noxious stimulus
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Term
| biopsychosocial view of pain? |
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Definition
that pain is perceived as a threat to biological integrity influencing a wide range of neuroendocrine and homeostatic mechanisms in order to restore normal function. |
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Term
| psychological view incorperates physical dysfunction with (4): |
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Definition
§ Beliefs and coping
§ Distress
§ Illness behaviour
§ The effects of social interaction
o Recognizes the role of consciousness in pain
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Term
1. What ost. Principles relates to the following:
social
psychosocial
biological
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Definition
s: person is one of mind/body/spirit
p: self healing etc & the body is a unit
B: structure and function are interrelated |
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Term
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Definition
Stress is caused by an existing stress-causing factor or “stressor”
Anxiety is stress that continues after the stressor is gone.
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Term
| physiologic response to stress: |
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Definition
· Involves activation of the hypothalamic-pituitary-adrenal (HPA) axis.
· Modulated by the ANS.
· ANS balance is maintained through SNS (fight/flight) and PSNS (rest/digest)
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Term
mismatch between the true needs of patients and the health care services offered leads to: |
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Definition
ú less effective care,
ú frustration for both patient
ú and physician,
ú waste of ever-shrinking health care resources.
ú There is a need to assess patients’ emotional distress.
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Term
· Treatment considerations for stress:
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Definition
o The osteopath should emphasize the importance of lifestyle alterations
- cutting down on caffeine - maintaining a healthy diet - quitting smoking
- exercising regularly
o Other stress-reduction strategies can be tailored to the patient’s lifestyle and can be a key component in disease prevention.
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Term
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Definition
SOAP – method of documenting osteopathic diagnosis:
· Subjective
· Objective
· Assessment
· Plan
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Term
| What is the goal of differential diagnosis? |
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Definition
direct further examination → most effective and appropriate treatment is given.
narrow the differential diagnosis as much as possible and ultimately arrive at one definite diagnosis.
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Term
| What are the objectives of diagnosis? |
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Definition
· Create a list of differential diagnoses that fit the symptoms
· Systematically eliminate least likely
· Present clear argument for support of the final diagnosis
· Understand biological mechanisms that are affected by the condition
· Write a clear, well-organised diagnosis
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Term
| What are the 6 elements of the clinical diagnostic model? |
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Definition
· Source of pain
· Stage of healing
· Causative factors
· Psychosocial aspects
· Other factors(precipitating, maintaining, risk factors)
· Contraindications
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Term
| What are the possible sources of pain? (finalbomb) |
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Definition
· Fascia/connective tissue
· Integument/Skin
· Neural
· Articular structures
· Lymphatics/immune
· Blood
· Organ/viscera
· Muscle
· Bone
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Term
| Stage of healing considerations? |
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Definition
· Reaction or Inflammatory Phase (Acute)
· Regeneration or Proliferative Phase (Subacute)
· Remodelling Phase
· Chronic Phase
· Recurrent Chronic (varying phases - any of above)
· None of the above (problem does not involve tissue injury & therefore stage of healing is irrelevant)
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Term
| Causative factors/processes? (vindicated acronym) |
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Definition
· Vascular
· Infectious
· Iatrogenic
· Neoplastic
· Neurological
· Drugs
· Inflammation
· Congenital
· Autoimmune
· Trauma
· Endocrine
· Developmental/Environmental
· Also: degenerative, psychological/ psychiatric, metabolic, emotional, pregnancy-related, compensatory/adaptive, biomechanical - others?
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Term
| When patients arecontinually stressed, they move through three response stages. what are they? |
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Definition
o First, there is astartle response and orienting reflexas the patient becomes aware of the stress and is biologically alarmed.Adrenal, cardiovascular, respiratory, and musculoskeletal functions increase.
o Next is an attempt tocope and problem-solve biologically, psychologically and socially
• • The patient mobilises all resourcesto meet and resist the stressor
• • If successful, mastery & learning occur
• • If not, the patient becomesexhausted physiologically, mentally, and emotionally
o The third stage, exhaustion, iswhat the osteopathic physiciansees clinically as a variety ofdysfunctional signs & symptomsaffecting any & all organ systems,including the neuromusculoskeletal network.
• • As coping responses fail, the exhaustion depletes adaptive reserves and resistance disappears. |
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Term
| what are the common consequences of continual stress? |
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Definition
o Fatigue
o Depression
o Anxiety
o Insomnia
o Musculoskeletal complaints
o Drug-seeking behaviours / substance abuse |
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Term
| describe 2 clinical approaches for patients with continual stress? |
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Definition
Change the stressor
Help the patient respond in healthy ways to the stress. |
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Term
| Associated symptoms of depression include (8): |
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Definition
Fatigue
• Feelings of worthlessness
• Excessive guilt
• Agitation
• Indecisiveness
• Insomnia or hypersomnia
• Diminished abilities to problem solve or concentrate
• Possible suicidal thoughts
(5 or more present in 2 weeks, depression diagnosis is considered) |
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Term
| Rx options for depression (4)? |
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Definition
o • Drug therapy
o • Exercise
o • OMT to decrease effects of stress-related disorders & somatic dysfunction |
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Term
| how does anxiety manifest in heightened autosomal arousal? |
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Definition
o Elevated heart rate
o Occasional heartbeat irregularities
o Blood pressure changes
o Sweating
o Intestinal distress
o Blood sugar changes
o Generalised muscle tension
o Decreased pain tolerance |
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Term
| what are the symptoms of anxiety? |
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Definition
Insomnia
• Excessive worrying
• Forgetfulness
• Irritability
• Difficulty concentrating
• Hypervigilance |
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Term
| what are the symptoms of panic attacks? |
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Definition
o Sweating
o • Trembling
o • Choking
o • Shortness of breath
o • Chest pain
o • Heart palpitations
o • Dizziness
o • Paraesthesia |
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Term
| discuss treatment aims for anxiety |
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Definition
Physical symptoms can be controlled
by relaxation, controlled diaphragmatic breathing, and biofeedback.
• Identify anxiety-generating thoughts
• Learn techniques to counter such thoughts
• Enhance coping abilities
• Provide interpersonal support
• Train the patient to reduce learned anxiety associated with environmental stimuli |
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Term
| discuss the acute (hyperaemic) phase of healing in regards to PAIN? |
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Definition
| o Pain is felt at rest & aggravated
by activity o Pain is felt over a relatively
diffuse area and may be referred
into any or all of the related segment (sclerotome) • Passive movement of related joints when limited is restricted by pain, muscle guarding, or both.
• The skin temperature over the site of the lesion is often elevated. |
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Term
| explain the Chronic / reparative phase of healing? |
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Definition
o No pain at rest and pain is felt
only with specific activities
o Pain is felt over a fairly
localized area, close to the site
of the lesion (often not directly
over the site of the lesion, however).
o Movement of related joints, when limited, is restricted by soft-tissue tightness
o Pain is felt only at the extremes of movement or through a small arc of movement. |
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Term
| list 3 important aspects to patient management? |
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Definition
1 - assessment of disability
2 - control functional status
3 - monitor functional status to judge improvement |
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Term
| what are the seven key componants to rehab treatment planning! |
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Definition
1. reduce stress
2. increase energy attenuating capacity
3. promote increased strength
4. increase afferent input
5. increase tissue extensibility
6. resume optimal activity levels
7. prevent recurrence |
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Term
| when planning a rehabilitative program, what should you base your judgements upon? |
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Definition
1. clinical evidence (objectived have been accomplished)
2. awareness of the nature of stresses
- This requires biomechanical assessment and analysis and familiarity with research related to biomechanical properties of musculoskeletal tissues under various conditions of loading and healing. |
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Term
| o A complete exercise prescription should contain: |
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Definition
• Goals of the exercise
Increased strength?
Increased endurance?
Increased mobility?
• Mode of exercise
Flexibility
strength
• Intensity
How much load or resistance?
How fast or slow?
• Duration
How many reps?
How long do they last?
• Frequency
Number of sets
Times per day
Times per week
• Progression
Incremental increase of:
• Intensity
• Duration
• Frequency |
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Term
| What are the 10 progressive outcomes of exercise prescription? |
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Definition
1. obtain a position of relief
2. passive stretching
3. active stretching
4. motion that promotes circulation
5. mobilisation of restrictions
6. strengthen weak areas
7. improve overall motion coordination
8. provide stability strength and endurance
9 exercise continuum
10. group activity |
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Term
| Explain the progressive cycle resulting from continued inactivity. |
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Definition
| weakness, ↓ resistance, & increasingly severe clinical consequences resulting from minor stresses. |
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Term
| What are the 5 stages of change? (re starting exercise program) |
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Definition
• Pre-contemplation: Presently no exercise. No plans to start in next 6 months.
• Contemplation: Presently no exercise. Thinking about starting in next 6 months.
Preparation: Presently some irregular exercise.
Action: Presently some regular exercise, begun only within
past 6 months.
• Maintenance: Presently regular exercise, has been doing so for longer than 6 months. |
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Term
| (GREEN STAR) How do you enhance complience to an exercise program? (7 points) |
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Definition
• Minimise injuries: Adhere to principles of exercise prescription
•Encourage group participation: Or exercise with a partner. Invite patient’s partner to become involved and support the training program
•Variety: Emphasise a variety of modes and enjoyment in program
• Incorporate behavioural techniques: Base the prescription on
theories of behaviour change
• Use periodic testing: Document progress, and give immediate feedback to reinforce behaviour changes
• Recognise accomplishments
• Exercise leaders: Should be qualified and enthusiastic. |
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Term
| consequences of overdosing strength exercises include: |
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Definition
- injury
- overwhelmed patient (may not attempt or give up easily) |
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Term
| Definition and aim of auto mobilisation? |
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Definition
• Definition: specific joint-mobilisation procedures performed by the patient.
• Aim: maintain or ↑ joint mobility |
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Term
| What are some advantages of automobilisation? (7) |
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Definition
o 1. Major emphasis is placed on a pain-free position at the end of a range, in which mobilisation can be most effective with regard to capsular stretch.
o 2. Often the patient can control pain more easily than the therapist can.
o 3. The patient can perform automobilisations several times a day independently.
o 4. This reduces the time and expense of formal treatment sessions.
o 5. Increased range of motion is possible without excessive force.
o 6. Little or no equipment is required; anything that is needed usually is available in the home.
o 7. The techniques are simple, easy to apply, and are not time-consuming. |
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Term
| what are some disadvantages of auto mobilisation? (5) |
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Definition
o 1. Some positions are awkward and/or difficult if there is limitation or pain elsewhere
• (e.g. spine or other joints)
o 2. Limited variety of techniques for some joints, such as the hip, because of poor accessibility.
o 3. Some techniques may not be possible or are poorly managed at certain joints.
o 4. Automobilisation techniques of the finger joints require that the patient be able to stabilise one part and mobilise another with the same hand. This is somewhat difficult, though not impossible.
o 5. The movements cannot be observed once the patient is independent, and the techniques may not be carried out correctly. |
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Term
| describe the principles of auto mobilisation. |
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Definition
o • For most techniques, patient either holds one part of the extremity from movement or provides a fulcrum over which movement can take place.
o • Mobilisation is carried out by Pt’s hand or by use of his/her body weight.
o • Movements are smooth & regular, gentle, rhythmic oscillations performed at the end of motion, 10-20 times (1 or 2 oscillations per second, or up to 3 or 4 per second in chronic conditions) without using excessive force.
o The part must be completely relaxed if treatment is to be effective
o • The handgrip (or stabilising belt) should be firm but should not produce pain.
o • The patient’s position must be comfortable, easy to maintain, and must allow complete control of movements
o It is also important that:
• • Patient knows the goals & principles of automobilisation thoroughly
• the patient is well motivated
• techniques are precise, easy and simple
• patient is seen periodically to determine whether the techniques are being carried out correctly and are effective
• techniques should be discontinues once normal range is achieved |
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Term
| Name the indications for cranial manipulation: |
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Definition
• Headaches
• Mild to severe whiplash strain and sprain injuries
• Vertigo and tinnitus
• Otitis media with effusion and serous otitis media
• Temporomandibular joint dysfunction
• Sinusitis |
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Term
| Name the contraindications for cranial manipulation: |
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Definition
• Space-occupying lesions
• Recent major trauma to the head, particularly if there was any loss of consciousness at the time
• Stroke (cerebrovascular accident)
• Acute intracranial bleeding and haemorrhage
• Increased intracranial pressure
• Acute skull fracture
• Certain seizure states (relative) |
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Term
| Define the primary respiratory mechanism: |
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Definition
• Descriptive term for
a basic physiologic phenomenon, which manifests as a rhythmic impulse in 2 ways:
o Motion present in the cranial sutures, and sacrum, known as the Cranial Rhythmic Impulse (CRI)
o motion throughout the body |
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Term
| LIst the 5 phenomina of the primary respiratory mechanism: |
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Definition
o 1) Motility of the nervous system
o 2) Fluctuation of the CSF
o 3) Mobility of intracranial and spinal membranes
o 4) Articular mobility of the cranial bones
o 5) Involuntary mobility of the sacrum between the ilia |
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