Ortho
5/26/99

Soft Tissue Injury
•	try to ID the area injured from muscle, tendon to ligament
•	different treatment for each
•	different time frame for treatment
•	Active Care
•	Acute—sharp, poignant; having a short and relatively severe course.  Acute in this instance is meant to designate the new condition of less than 12 months duration
•	Mild: by nature this condition is uncomplicated and usually does not require rehab or supportive care.  This category of condition does require relief care and may require therapeutic care.  Only need further care if re-injure or exacerbate the injury
•	moderate: commonly requires rehab but no supportive care
•	severe:  requires all 4 levels of care; may not get back to where they were before the injury
•	subacute—something in b/w acute and chronic
•	Chronic—persisting a long period of time.  Chronic in this instance is meant to designate the long-standing, recurring condition of more than 12 months duration
•	mild: w/o acute exacerbation, no relief care, other 3 levels
•	moderate: w/acute exacerbation, all 4 levels; ex:  DJD
•	severe: w/serious, acute exacerbation, expanded periods of all 4 levels; ex:  disc
•	acute exacerbation—may be used to describe a sharp or severe aggravation of symptoms or an increase in the severity of a condition

Acute Condition
types of condition	levels of care	frequency	duration	
mild	relief
therapeutic
rehab
supportive	daily visits to 3 /wk
3 visits/wk to 1 visit/wk
none
none	1-15 days
0-30 days
none
none	
moderate	relief
therapeutic
rehab
supportive	daily visits to 3 /wk
3 visits/wk to 1 visit/wk
1 visit a wk to 2 visits/month
2 visits/month to 1 visit/month	7-21 days
30-60 days
30-60 days
0-3 months	
severe	relief
therapeutic
rehab
supportive	daily visits to 3 /wk
3 visits/wk to 1 visit/wk
1 visit a wk to 2 visits/month
2 visits/month to 1 visit/month	21-45 days
30-90 days
45-90 days
3-5 months	
•	in general, rehab has started w/pain free ROM
Chronic Conditions 
types of condition	levels of care	frequency	duration	
mild	relief
therapeutic
rehab
supportive	none
3 visits/wk to 2 visit/wk
2 visits/wk to 2 visit/wk
2 visits/mon to 1 visit/mon	none
14-45 days
45-90 days
3-6 months	
moderate	relief
therapeutic
rehab
supportive	daily visits to 3 /wk
3 visits/wk to 1 visit/wk
1 visit a wk to 2 visits/month
2 visits/month to 1 visit/month	14-45 days
45-90 days
90-180 days
6-12 months	
severe	relief
therapeutic
rehab
supportive	daily visits to 3 /wk
3 visits/wk to 1 visit/wk
1 visit a wk to 2 visits/month
2 visits/month to 1 visit/month	30-60 days
60-120 days
90-180days
6-18 months	

•	preventive/maintenance care
•	Pt management directed toward maintaining optimal body function.  This is management of the asymptomatic pt who has reached preclinical status or maximum medical improvement when the condition is resolved or stable

Whiplash
•	rear-end collision
•	many factors go into the energy
•	head remains stationary while the body is accelerating forward due to the seat moving
•	this starts the first hyperextension
•	ramping—car accelerates w/the pelvis in the seat, a force draws part of the seat back, w/o a lap belt the pelvis moves up the seat adding to the hyperextension of the cervical spine
•	hyperflexion
•	deceleration 
•	body still has an acceleration moment throwing the person into flexion
•	reflex contraction of the anterior cervical musculature—pulls the head into flexion
•	improper relationship to the head rest—apex of head rest at EOP and the distance is no more than 4 inches (at close distances helps block hyperextension; at further distance acts like a catapult)
•	presence of seatbelt—creates its own soft tissue injuries—hold thorax and lets head fly forward, holds left shoulder down and allows right shoulder to rotate to the left 
•	airbag—reduce injuries esp face and chest crushing injuries
•	minor injuries it creates

Post-concussive
•	brain injury that doesn't require loss of consciousness
•	battery of the brain inside the skull