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Characteristics and Clinical Signs, Rehab Interventions, Contraindications and Precautions During the Stages of Inflammation
Terms in this set (52)
The acute stage of inflammation is also know as the ________ _____________ stage.
TRUE OR FALSE: the acute stage of inflammation is considered the "moderate protection" phase.
FALSE! the acute stage is considered the "MAXIMUM protection" phase.
What are the characteristics of the acute stage of inflammation?
-exudation of cells and chemicals
-phagocytosis neutralizes irritants
-early fibroblastic migration
The acute stage of inflammation usually occurs during the first ___ hours, late stage usually resolves within ___ to ___ days.
The acute stage of inflammation usually occurs during the first 48 hours, late stage usually resolves within 4 to 6 days.
What are the clinical signs and symptoms seen/observed during the acute stage of inflammation?
-The cardinal signs of inflammation: red, hot, swollen, painful, and limited movement.
TRUE OR FALSE: your patient, who is the in the acute stage of inflammation, will report having pain before the end of his/her ROM.
TRUE! they will report pain before tissue resistance is felt.
What physical therapy goals will your patient in the acute stage of inflammation have?
-control effects of inflammation
-prevent problems from "rest"
What types of PT interventions will you use with your patient in the acute stage of inflammation?
-gentle cautious movements: PROM, AAROM
E-stim, pulsatile modalities, contrast thermals
-skin and soft tissue protection
Your patient, in the acute stage of inflammation, is complaining of increased pain. You also observe he/she has had an increase in inflammation. What does this indicate?
Increased pain and inflammation are signs of too much movement. Proper dosage of rest and movement are important during this stage. (PRECAUTION)
What contraindications should you be aware of for the acute stage of inflammation?
Stretching and resistance exercises should NOT be performed at the site of the inflamed or swollen tissue.
INTERVENTIONS (ACUTE STAGE): The patient should be educated on....
-precautions, contraindications and limitations on activity
-nature of symptoms
-pain/spasm cycle prevention
INTERVENTIONS (ACUTE STAGE): How can we work with the patient to minimize edema?
-selective rest and positioning (elevation)
INTERVENTIONS (ACUTE STAGE): TRUE OR FALSE: Massage is safe, if indicated.
INTERVENTIONS (ACUTE STAGE): How can we work with the patient to inhibit or gait pain and improve fluid dynamics?
Low-dose joint mobilization techniques (grade I or grade II)
INTERVENTIONS (ACUTE STAGE): TRUE OR FALSE: gentle isometrics (muscle setting) with CAUTION (can help with blood flow)
INTERVENTIONS (ACUTE STAGE): How can we work with the patient to ensure protection of their injured tissues?
Through the use of bandaging, casts, splints, braces, pressure garments, etc.
INTERVENTIONS (ACUTE STAGE): If it is indicated for the patient to begin mobility and gait training, what will we as the PTA need to do?
Fit and train the patient to use adaptive devices for mobility and gait, IF SAFE and indicated.
The sub-acute stage of inflammation is also called the ______ and _______ stage.
repair and healing
TRUE OR FALSE: the sub-acute stage is considered the "MODERATE protection" stage.
TRUE! "MOD protection, controlled motion"
What are the characteristics of the sub-acute stage of inflammation?
-removal of noxious stimuli, decreasing inflammatory signs
-growth of capillary beds into damaged tissue
-granulation tissue formation
-tissue very fragile, easily
The sub-acute stage of inflammation can begin as early as the ___ to ___ day after tissue injury and can last as long as ___ weeks. ALTHOUGH normally, healing of tissues occurs within ___ to ___ days or ___ to ___ weeks.
The sub-acute stage of inflammation can begin as early as the 2nd to 4th day after tissue injury and can last as long as 6 weeks. ALTHOUGH normally, healing of tissues occurs within 14 to 21 days or 2 to 3 weeks.
What are the clinical signs and symptoms we would expect to see during the sub-acute stage of healing?
-decreasing redness, heat, edema, pain, with easier movements.
TRUE OR FALSE: your patient, in the sub-acute stage of inflammation, will report pain when pressure is applied at the end of their ROM.
FALSE!! pain is expected to be felt at the END OF ROM when tissue resistance is felt. (BEFORE over pressure can be applied).
What PT goals would you expect to have for the patient in the sub-acute stage of inflammation?
-prevent or minimize contractures and adhesions (mobilize scar)
-promote healing (active use) as allowed.
What types of PT interventions will you use with your patient in the sub-acute stage of inflammation?
-Gentle AROM activities, gradually increasing intensity and ROM
-Continue modalities to promote healing and minimize inflammation AS NEEDED.
-Monitor fit and need of support/protective devices.
What usually occurs, referring to the signs of inflammation or joint swelling, during the sub-acute stage of healing?
They usually decrease early in this stage.
Your patient in the sub-acute stage of inflammation is complaining of pain when they rest. They also report having increased fatigue and muscle spasms that last longer than 24 hours. They state to you, "I feel like i'm getting weaker". What does this indicate?
These are signs of too much motion/activity. (PRECAUTION)
What should your patient be informed of that may occur with progression?
discomfort may occur, but it should not last more than a couple of hours.
INTERVENTIONS (SUB-ACUTE): Patient education should consist of...
-education regarding symptoms and energy conservation
-encouraging return to functional, recreational and work related activities on a closely monitored basis
-creating, monitoring and progressing home exercise programs
INTERVENTIONS (SUB-ACUTE): Your patient is talking to you on your way to the gym before his treatment and tells you how much better he is doing/feeling. What is something you should caution him about?
You should advise caution to this patient (in the sub-acute stage) that even though he is feeling/doing better, his tissues are still very fragile. He should avoid over activity because he can easily re-injure his newly healing injury.
INTERVENTIONS (SUB-ACUTE): modalities can be used during this stage (as needed) for what purpose?
-control pain, minimize edema, promote healing, decrease stiffness.
-may alternate between ice/heat, electrical modalities, etc.
INTERVENTIONS (SUB-ACUTE): your patient may now being active exercise! What are some examples of active exercise appropriate for their stage of healing?
-AROM in pain free ROM
-Multi-angle sub-maximal isometrics, beginning in relaxed positions progressing angles toward shortened muscle state within pain range
-protected closed-chain activities (PWB)
-begin eccentrics with lower weight
INTERVENTIONS (SUB-ACUTE): If your patients muscle or tendon is not involved, what exercises may you begin?
low weight PREs, beginning eccentrics with lower weights to minimize DOMS, progressing to concentrics and slowly increasing weights based on pain symptoms and exercise tolerance.
INTERVENTIONS (SUB-ACUTE): It is now safe to begin a gentle, controlled stretching program! What 3 steps should you follow?
1st: warm tissues (could be with heat pack or gentle exercise to "warm up").
2nd: apply muscle inhibition, relaxation and massage techniques, and gentle progressive joint mobilization if surgically allowed, followed by gentle passive stretching techniques
3rd: ending with active recruitment of muscle contractions and functional use at newly acquired ROM, encouraging home exercises using new ROM.
INTERVENTIONS (SUB-ACUTE): you may also want to begin cardiovascular endurance activities, if appropriate. How would you go about doing so?
Begin low level endurance activities with injured tissue...
-you can start aquatics, stabilization activities, controlled weight bearing and eccentrics.
The chronic stage of inflammation is also referred to as the __________ and __________ stage.
maturation and remodeling stage
TRUE OR FALSE: the chronic stage of inflammation is considered the "MINIMUM protection" stage.
TRUE! MINIMUM protection/Return to function.
What are the characteristics of the chronic stage of inflammation?
-maturation of connective tissue
-contracture of scar tissues
-remodeling of scars and adhesions
-collagen aligns to patterns of use and stretch
The chronic stage of inflammation can begin as early as day ___, but most commonly around day ___. This stage may last for _______ ______ , although most are well healed within ___ days (___ months).
The chronic stage of inflammation can begin as early as day 9, but most commonly around day 21. This stage may last for several months, although most are well healed within 60 days (2 months).
TRUE OR FALSE: during the chronic stage of inflammation, you should see NO clinical signs of inflammation (red, hot, swollen, pain, LOM).
TRUE! no clinical signs of inflammation should be present.
When would you expect your patient in the chronic stage of inflammation to report pain?
At the end of their ROM when pressure is applied. "patient reports pain only after pushing beyond tissue resistance (stretch)"
What PT goals would you expect to have for a patient in the chronic stage of inflammation?
-increase tensile quality of scar
-develop functional independence
-restore or maximize functional ability
What are some PT interventions you would use for your patient in the chronic stage of inflammation?
-Progressive stretching/soft tissue mobilization
-PRE/PNF/Manual resistance, progress strengthening
-Functional activity and endurance training
-Education and prevention
TRUE OR FALSE: your patient in the chronic stage of inflammation is still expected to have minor signs of inflammation.
FALSE! during the chronic stage of inflammation, there are no signs of inflammation.
Your patient, in the chronic stage of inflammation, reports playing in a 5 match a day tennis tournament last weekend (Friday, Saturday and Sunday). Knowing that the patient has "over-done it", what would you expect his complaints to be?
-pain lasting more than 4 hours or requiring medication for relief
-reports of decrease in strength or fatiguing more easily
INTERVENTIONS (CHRONIC): Patient education during this stage should consist of...
-Safe progression of strengthening and stretching home programs
-injury prevention, safe body mechanics, ergonomic counseling.
your patient should be aware that progression may lead to discomfort. They should know this discomfort should not last longer than....
a couple of hours.
TRUE OR FALSE: during the chronic phase, it is suitable to being MORE AGGRESSIVE joint mobilization, friction massage and muscle stretching techniques.
INTERVENTIONS (CHRONIC): your patient can now be progressed with their muscle strengthening programs. How will you go about this?
Progress their muscle strengthening programs to a more challenging level: both open and closed chain activities, plyometrics, multi-directional strengthening patterns (PNF) against heavy resistance, isokinetics.
INTERVENTIONS (CHRONIC): TRUE OR FALSE: the patient in the chronic phase of healing should focus less on truck stability, balance and posture because muscle strength is the main focus of this phase.
FALSE!! this patients interventions should ALSO INCLUDE: refinement of trunk stability, balance and postural control activities while incorporating extremity coordination and strengthening activities.
INTERVENTIONS (CHRONIC): TRUE OR FALSE: work conditioning and work hardening activities should be included in your interventions for this patient.
INTERVENTIONS (CHRONIC): TRUE OR FALSE: during this stage, endurance activities involving injured tissue should still be avoided.
FALSE! injured tissue and cardiovascular endurance should both be challenged with endurance activities.
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